Feasibility and preferences of an advanced care planning model in patients with mild cognitive impairment and mild dementia

Abstract

Objective: We want to explore the feasibility in terms of time consumption, patient satisfaction and to analize care preferences in an advanced care and decision making planning model in patients with mild cognitive impairment and mild dementia.

Background: Advanced care planning is a deliberation process between the patient, family and the healthcare professional who seeks to explore the values, preferences, wishes and concerns before and during the course of the disease until the end of it, ahead of time, before losing the ability to decide.

Design/Methods: Design: observational, descriptive, prospective, transversal study. Patients diagnosed of mild cognitive impairment(MCI) and mild dementia(MD) (GDS 1–3) attended in general neurology clinic between February and April 2019 were selected.

Results: 27 consecutive patients and performed a semistructured 3 block interview (LAGUNAdvance model). Age:75.19yo ± 9.04. Female:59%. Completion rate(%)/Mean time spent(min,sec): Block 1(Disease Knowledge/general aspects):89% /03m 02s; block 2(Disease facing and representative): 78% /04m 30s; block 3(Care planning): 74%/04m 11s. Total interview time 11m59s ± 4m36s. Satisfaction rate: satisfied/very satisfied 76%. Preferences: 93% want to know deeper on their disease and 56% future complications. 85% know what person they want as representative(78% partner). 67% consider important to respect their values/way of thinking. 95% want palliative care at the end of life. 68% reject enteral feeding. 86% prefer to die unconscious. 67% wish to be attended at home in end phase. 62% would like to receive spiritual attention.

Conclusions: It is feasible to carry out an advanced care planning model for patients with MCI and MD in neurology outpatient consults. The LAGUNAdvance model proposed is satisfactory with a high degree of compliance. The patient wishes to be informed of specific aspects and future complications of the disease. The majority choose their partner as legal representative, refuse enteral feeding, want palliative care, want to die unconscious at home and receive spiritual attention.