In a paper published by the Journal of General Internal Medicine, researchers from the University of Pittsburgh School of Medicine ask fellow physicians the question, “Would you be surprised if this patient died this year?” to advocate for advance care planning (ACP) for patients with substance use disorders (SUDs).
ACP involves discussing future and end-of-life care, establishing a surrogate decision maker, and completing an advanced directive. Study authors Michelle Fleshner, M.D., M.P.H., internal medicine resident at UPMC Montefiore, and Julie Childers, M.D., M.S., medical director of the hospital-based palliative care consultation service at UPMC Presbyterian, state that strong patient-provider relationships are key to ensuring people’s wishes for end-of-life care are known.
“While it is important to continue treatment for patients with substance use disorders, physicians need to be realistic about the mortality risks these patients have,” said Fleshner, lead author of the paper. “Anyone living with a substance use disorder should have a surrogate decision maker to help them plan for their future.”
According to Fleshner and Childers, research has found that ACP is associated with improved quality of end-of-life care that is more consistent with patient preferences.
Fleshner and Childers argue that primary care physicians should screen and counsel SUDs patients like they would a patient with any other chronic disease, like diabetes or heart failure. Research cited by the authors has shown that marginalized and high-risk patients, such as those with SUDs, are less likely to receive ACP and often struggle to continue care after both detox and long-term rehabilitation.
“Individuals with substance use disorders have elevated mortality risks for reasons beyond overdosing. Alcohol and opioid users are prone to issues like liver disease, cardiovascular disease, a variety of cancers and even suicide,” said Childers. “Oftentimes substance use disorder patients are unable to make decisions for themselves, and prioritizing ACP can guide them and their loved ones in the event of serious illness.”