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26-03-2013 | General practice | Article

Routine planning results in patients' preferred place of death


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medwireNews: Conducting advanced care planning (ACP) during the last year of life is not only feasible but results in three-quarters of patients dying in their preferred location, show UK study results.

ACP also reduces the mean number of days spent in hospital and overall hospital costs, indicate the findings.

"Use of ACP is an integral part of the End of Life Care Strategy [in the UK]. If we are going to offer choices about place of death to people with terminal diagnoses, we need to be able to identify them and have the discussion around ACP with sufficient time," say Julian Abel (Weston Area Health Trust, Weston-super-Mare) and co-workers.

They add that the approach appears to be justified in both cancer and noncancer settings; of the 969 individuals included in the study cohort, over half (56%) completed ACP, which included a similar proportion of those with cancer as those without.

Abel and colleagues analyzed ACP use and outcomes over a 2.5-year period among individuals who died between January 2009 and June 2011.

Participants were aged a mean of 75 years at time of death; 32% died at home, and a total of 87% had a cancer diagnosis. ACP comprised versions of the Preferred Priorities for Care, Putting Affairs In Order, and Advanced Decision To Refuse Treatment documents.

The majority of both cancer and noncancer patients expressed a preference to die at home, at 53% and 67%, respectively, and overall, 75% of the entire cohort achieved their preferred place of death. Indeed, just 11% of participants who had completed ACP died in hospital, as reported in the BMJ Supportive and Palliative Care.

The mean number of days spent in hospital in the last year of life was significantly higher among those who eventually died in hospital compared with those who did not, at 26.5 versus 20.5 days.

Similarly, mean hospital costs in the last year of life were significantly higher, by £ 3569 (€ 4185, US$ 5436), for those who died in hospital than for those who did not.

"This may indicate that decision making about the use of chemotherapy has already been optimised to reflect end of life care," suggest the authors.

By Sarah Guy, medwireNews Reporter

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