To assess the effect of goals of care conversations between persons with dementia (PWD) and their caregivers on advance care planning outcome measures.

Advance care planning allows PWD to specify preferences for when they can no longer participate in medical decisions. However, end of life decision-making remains challenging despite increasing rates of advance directive completion and durable power of attorney designation. Advance care planning is increasingly viewed as an ongoing process of communicating and planning for future care, yet the effect of goals of care conversations between PWD and their caregivers is not well characterized.

Retrospective cohort study using data from the Care Ecosystem trial, a telephone-based support intervention for community dwelling PWDs and their caregivers. Data on demographics, dementia severity, and comorbidities were collected at baseline. Additional advance care planning measures were collected via a questionnaire administered to caregivers after the death of the PWD.

We identified 161 PWD-caregiver dyads with completed baseline and postmortem questionnaires. At time of death, the majority of PWD had advance directives (93.5%), durable powers of attorney (96.7%), and conversations with their caregiver about goals of care (78.3%). In nested multivariate logistic regressions adjusting for both patient and caregiver characteristics, goals of care conversations between PWD and their caregivers were significantly associated with advance directive usefulness, advance directive compliance, and PWD dying at their desired place of death. Goals of care conversations were not significantly associated with disagreements around end of life care.