The impact of advance care planning of place of death, a hospice retrospective cohort study. Issue 2 (14th March 2013)

• Record Type: Journal Article
• Authors: Abel, Julian; Pring, Andy; Rich, Alison; Malik, Tariq; Verne, Julia
• Is Part Of: BMJ supportive & palliative care. Volume 3:Issue 2(2013)
• Page Start: 168
• Page End: 173
• Publication Date: 2013-03-14
• Subjects: Hospice care -- Cancer -- Chronic conditions -- Communication -- Service evaluation; Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2012-000327
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Objectives: There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year. Results: 969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group(p<0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11, 299, those dying outside of hospital £7, 730 (p<0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p<0.001). Conclusions: ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008.