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Identifying triggers for optimal timing of advance care planning in electronic primary health care records: a nested case-control study
Willemijn Tros, Jenny Theodora van der Steen, Mattijs Everard Numans, Marta F. Fiocco, Petra G. van Peet. BMJ Open, 2025-11-01
Topic: Risk, prevention and care in population studies
We included 17098 records, 4139 from deceased individuals (mean age 81) and 12959 from living individuals (mean age 79). Triggers most strongly associated with death were consultations concerning malignancy (OR 8.35, 95% CI 7.42 to 9.41), hospital admissions (OR 7.32, 95% CI 6.75 to 7.94), emergency department referrals (OR 7.11, 95% CI 6.52 to 7.75), registered home visits (OR 5.97, 95% CI 5.51 to 6.47), consultations concerning heart failure (OR 5.25, 95% CI 4.59 to 5.99), dementia (OR 4.75, 95% CI 3.99 to 6.56), opioid prescriptions (OR 4.58 (4.25-4.93), consultations concerning general decline/feeling old (OR 4.15, 95% CI 3.72 to 4.64) and skin ulcers/pressure sores (OR 4.04, 95% CI 3.55 to 4.61). Those closest to the median of the optimal time window for ACP were consultations regarding dyspnoea, general decline/feeling old, heart failure, skin ulcers/pressure sores and fever, opioid prescriptions, emergency department referrals, registered home visits and hospital admissions. Clinical triggers for initiating ACP in general practice can be recognised within the routine electronic health records and they align well with the 'window of opportunity' to initiate ACP.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Tros, W., van der Steen, J. T., Numans, M. E., Fiocco, M. F., & van Peet, P. G. (2025). Identifying triggers for optimal timing of advance care planning in electronic primary health care records: a nested case-control study. BMJ Open. https://doi.org/10.1136/bmjopen-2025-104742
Vancouver
Tros W, van der Steen JT, Numans ME, Fiocco MF, van Peet PG. Identifying triggers for optimal timing of advance care planning in electronic primary health care records: a nested case-control study. BMJ Open. 2025. doi:10.1136/bmjopen-2025-104742. PMID: 41320208.
BibTeX
@article{tros2025-41320208,
author = {Tros, Willemijn and van der Steen, Jenny Theodora and Numans, Mattijs Everard and Fiocco, Marta F. and van Peet, Petra G.},
title = {{Identifying triggers for optimal timing of advance care planning in electronic primary health care records: a nested case-control study}},
journal = {BMJ Open},
year = {2025},
doi = {10.1136/bmjopen-2025-104742},
pmid = {41320208},
url = {https://doi.org/10.1136/bmjopen-2025-104742}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- We included 17098 records, 4139 from deceased individuals (mean age 81) and 12959 from living individuals (mean age 79).
- Triggers most strongly associated with death were consultations concerning malignancy (OR 8.35, 95% CI 7.42 to 9.41), hospital admissions (OR 7.32, 95% CI 6.75 to 7.94), emergency department referrals (OR 7.11, 95% CI 6.52 to 7.75), registered home visits (OR 5.97, 95% CI 5.51 to 6.47), consultations concerning heart failure (OR 5.25, 95% CI 4.59 to 5.99), dementia (OR 4.75, 95% CI 3.99 to 6.56), opioid prescriptions (OR 4.58 (4.25-4.93), consultations concerning general decline/feeling old (OR 4.15, 95% CI 3.72 to 4.64) and skin ulcers/pressure sores (OR 4.04, 95% CI 3.55 to 4.61).
- Those closest to the median of the optimal time window for ACP were consultations regarding dyspnoea, general decline/feeling old, heart failure, skin ulcers/pressure sores and fever, opioid prescriptions, emergency department referrals, registered home visits and hospital admissions.
- Clinical triggers for initiating ACP in general practice can be recognised within the routine electronic health records and they align well with the 'window of opportunity' to initiate ACP.
Why it matters
This nested case-control study identified clinical triggers in electronic primary health care records, such as consultations concerning malignancy, hospital admissions, and dementia, that were associated with death and could help time advance care planning. It suggests these triggers can be recognised in routine records and align with the window of opportunity to initiate advance care planning.
Study details
- Study designcase-control study
- Participants17,098
- Effect sizeOR 8.35; OR 7.32; OR 7.11
- Evidence strengthModerate
How this study scored 53/100
Published in a peer-reviewed journal, and it is a case-control study. Scored zero for randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMJ Open) |
| Journal's citation record | 2 / 4 | BMJ Open: journal h-index 240 (OpenAlex, 2026-10-29) |
| Study design | 6 / 12 | A case-control study |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 17,098 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Petra G. van Peet: h-index 17 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | King's College London: institution h-index 1,348 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41320208) |
| Free to read | 2 / 2 | Free to read |
| Total | 53 / 100 | — |
What each of these 20 components measures, and what this score is not →
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