Objective:

This study aims to determine prevalence of Advanced Care Planning (ACP) within stroke patients and characterize those with and without ACP documentation in order to identify potential racial disparities in ACP.

Background:

ACP is associated with improved quality of life for patients and caregivers. As stroke survivors have high mortality and morbidity within 1 year, most stroke patients are ideal candidates for ACP.

Design/Methods:

This is a retrospective study of all patients discharged from the stroke service at a comprehensive stroke center between January 2022 and April 2024. Patients with Physician Orders for Life Sustaining Treatment (POLSTs), Advanced Directives (ADs) or no ACP documentation uploaded into the Electronic Medical Record (EMR) were identified. Clinical characteristics of patients with and without ACP documents were compared using chi-square and Wilcoxon rank-sum tests.

Results:

Out of 1333 patients, 263 (19.73%) had ACP documents uploaded to the EMR. Of those who had ACP documents, 139 (10.43%) had POLSTs, 85 (6.38%) had ADs and 39 (2.93%) had both. Of the 178 POLSTS, 69 (38.76%) were signed prior to admission, 29 (16.29%) were signed during hospitalization and 80 (44.94%) were signed after discharge. The median age of those with ACP documents was significantly higher than those without (76 vs. 66, p< .0001). Those with ACP documents were significantly more likely to be Caucasian than belong to a racial minority group (African American, Asian, Hispanic, Other, Unknown, p< .0001).

Conclusions:

Less than 20% of patients had ACP documents uploaded to EMR and most ACP was done post-discharge. Stroke patients with ACP documents are less likely to be part of a racial minority group. This suggests the need for culturally-competent patient and provider education to increase early ACP engagement in stroke patients.