JMIR Publications

ABSTRACT

Background:

Advance care planning is the process of discussing health care treatment preferences based on patients’ personal values and often includes the completion of advance directives. In the first months of 2020, the novel coronavirus SARS-CoV-2 began circulating widely in Colorado, USA, leading to widespread COVID-19 diagnosis, hospitalizations, and deaths. In this context, technology-based, non-face-to-face methods to conduct advance care planning via patient portals became increasingly important.

Objective:

Determine the rates of online advance care planning tool use through a health system-based electronic patient portal, before and in the early months of the COVID-19 pandemic.

Methods:

In 2017, we implemented online tools for patients to learn about advance care planning and complete an electronically-signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. The tools are available through the patient portal of UCHealth’s electronic health record (EHR). UCHealth cares for 1.9 million patients in 12 hospitals and associated clinics in Colorado and parts of Wyoming and Nebraska. The advance care planning tools also provide patient-centered education and include an option to send an electronic message with questions to a UCHealth staff member. Patients accessing the portal can complete and submit a legally valid MDPOA that becomes a part of their medical records. We collected data on patients’ date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phases of the COVID-19 pandemic (December 29, 2019 to May 30, 2020).

Results:

Over a five-month period that includes the early COVID-19 pandemic in Colorado, total monthly advance care planning portal tool use increased from 418 users in January to 1037 users in April, and then was slightly lower with 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the Colorado “stay-at-home” order was issued on March 26, 2020 (p<0.0001). Portal advance care planning users were mean age of 47.7 (16.1) years and 67% female. The largest age group of users were 25-35 years of age (22%), compared to age 65 years of age and older (19%). Females were more likely to complete an MDPOA particularly in younger age groups (p<0.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (95.3%), compared to sending an electronic message (4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR.

Conclusions:

Use of an online patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government “shelter in place” orders, as well as public health reports of increased COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure medical treatment aligns with patient goals and values.