Advance Care Planning and Decision Regret Among Stroke Surrogate Decision Makers: A Longitudinal Cohort Study.

Abstract

Investigate the association between advance care planning and decision regret among stroke surrogate decision makers. People hospitalized with ischemic or hemorrhagic stroke and their surrogate decision makers were enrolled. Surrogates completed the validated decision regret scale (range 0-100, higher worse, analyzed as "any" vs "none") in the year after stroke (postdischarge, 3, 6, and 12 months). The association of advance care planning and regret was assessed with multilevel mixed effects logistic regression models, adjusted for prespecified covariates. Participants were 317 surrogates for 255 patients with stroke (enrolled April 2016 to October 2020). Patients had a mean age of 74.6 years and mean NIH Stroke Scale of 14.7, with 53% deceased at 3 months. Surrogate characteristics were mean age: 55.8 years, child of patient: 62%, and decision considered (do-not-resuscitate 36%, comfort care 16%, feeding tube 14%, mechanical ventilation 14%, brain surgery 10%, and other 10%). Overall, 132/317 (42%) surrogates reported formal advance care plans. Decision regret scores overall were low (postdischarge mean: 11.2). Formal written advance care plans were associated with lower odds of any decision regret (odds ratio 0.46, 95% CI 0.24-0.89, <i>p</i> = 0.02) after full adjustment. Formal written advance care plans were associated with lower odds of any decision regret among surrogate decision makers in the year after stroke.