Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives. Academic Article Article uri icon

Overview

MeSH

  • Female
  • Humans
  • Male
  • Prevalence
  • Resuscitation Orders
  • Right to Die
  • Risk Factors
  • United States

MeSH Major

  • Advance Directives
  • Health Care Costs
  • Neoplasms
  • Quality of Life
  • Terminal Care

abstract

  • Advance directives (ADs) are expected to improve patients' end-of-life outcomes, but retrospective analyses, surrogate recall of patients' preferences, and selection bias have hampered efforts to determine ADs' effects on patient outcomes. The aim was to examine associations among ADs, quality of life, and estimated costs of care in the week before death. We used prospective data from interviews of 336 patients with advanced cancer and their caregivers and analyzed patient baseline interview and caregiver and provider post-mortem evaluation data from the Coping with Cancer study. Cost estimates were from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and published Medicare payment rates and cost estimates. Outcomes were quality of life (range 0-10) and estimated costs of care received in the week before death. Because patient end-of-life care preferences influence both AD completion and care use, analyses were stratified by preferences regarding heroic end-of-life measures (everything possible to remain alive). Most patients did not want heroic measures (76%). Do-not-resuscitate (DNR) orders were associated with higher quality of life (β = 0.75, standard error = 0.30, P = 0.01) across the entire sample. There were no statistically significant relationships between DNR orders and outcomes among patients when we stratified by patient preference or between living wills/durable powers of attorney and outcomes in any of the patient groups. The associations between DNR orders and better quality of life in the week before death indicate that documenting preferences against resuscitation in medical orders may be beneficial to many patients. Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.

publication date

  • May 2015

has subject area

  • Advance Directives
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Neoplasms
  • Prevalence
  • Quality of Life
  • Resuscitation Orders
  • Right to Die
  • Risk Factors
  • Terminal Care
  • United States

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC4441858

Digital Object Identifier (DOI)

  • 10.1016/j.jpainsymman.2014.09.015

PubMed ID

  • 25498855

Additional Document Info

start page

  • 828

end page

  • 835

volume

  • 49

number

  • 5