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J Palliat Med. 2015 Jan;18(1):62-6. doi: 10.1089/jpm.2014.0031.

The power of advance care planning in promoting hospice and out-of-hospital death in a dialysis unit.

Author information

1
1 West Virginia University Schools of Medicine , Morgantown, West Virginia.

Abstract

BACKGROUND:

Despite mortality rates that exceed those of most cancers, hospice remains underutilized in patients with end-stage renal disease (ESRD) on dialysis and nearly half of all dialysis patients die in the hospital.

OBJECTIVE:

To review the impact of advance care planning on withdrawal from dialysis, use of hospice, and location of death.

DESIGN:

Retrospective review.

SETTING:

A rural outpatient dialysis unit.

PARTICIPANTS:

Former dialysis patients who died over a 5-year period.

EXPOSURE:

Advance care planning, the use of physician orders for life-sustaining therapy program (POLST).

MAIN OUTCOME AND MEASURE:

Use of hospice among patients withdrawing from dialysis, location of death.

RESULTS:

Advance care planning was associated with a low incidence of in-hospital death and among those who withdrew, a high use of hospice.

CONCLUSIONS AND RELEVANCE:

Comprehensive and systematic advance care planning among patients with ESRD on dialysis promotes greater hospice utilization and may facilitate the chance that death will occur out of hospital.

PMID:
25006866
PMCID:
PMC4273198
DOI:
10.1089/jpm.2014.0031
[Indexed for MEDLINE]
Free PMC Article

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