Case‐control study of end‐of‐life treatment preferences and costs following advance care planning for adults with end‐stage kidney disease

• Published in: Nephrology (Carlton, Vic.) Vol. 24; no. 2; pp. 148 - 154
• Main Authors: Sellars, Marcus, Morton, Rachael L, Clayton, Josephine M, Tong, Allison, Mawren, Daveena, Silvester, William, Power, David, Ma, Ronald, Detering, Karen M
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.02.2019; Wiley Subscription Services, Inc
• Subjects: Adult; advance care planning; Advance Care Planning - economics; Advance directives; Aged; Aged, 80 and over; Attitude of Health Personnel; chronic kidney disease; conservative care; cost‐effectiveness; Dialysis; Dialysis - economics; Female; Hospital Costs; Humans; Kidney diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - economics; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Male; Middle Aged; nephrology; Nursing Service, Hospital - economics; Outcome and Process Assessment (Health Care) - economics; Patient Preference - economics; Patients; Practice Patterns, Nurses' - economics; Practice Patterns, Physicians' - economics; Retrospective Studies; Terminal Care - economics; Time Factors; Treatment Outcome; nephrology; conservative care; cost-effectiveness; chronic kidney disease; advance care planning
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13230

ABSTRACT Aim The aim of the present study was to examine the efficacy of advance care planning (ACP) to improve the likelihood that end‐stage kidney disease (ESKD) patient’s preferences will be known and adhered to at end‐of‐life. Methods A case‐control study of a nurse‐led ACP programme in adults with ESKD from a major tertiary hospital. The primary outcome was the proportion of patients whose preferences were known (by substitute decision maker and/or clinicians) and adhered to by their treating doctors. Secondary measures were health system resource use and costs ($AUD) for a nurse‐led ACP intervention in the last 12‐months of life. Results In total, 57 cases (38 men, mean age 73.8 years) and 57 historical controls (38 men, mean age 74.0 years) were included. Cases (38/57, 67%) were significantly more likely than controls (15/57, 26%) to have their preferences known and adhered to by their treating doctor at end‐of‐life (P < 0.001). Cases (33/40, 83%) were also significantly more likely to withdraw from dialysis in accordance with their preferences than controls (11/33, 33%) (P < 0.001). For cases, the average hospital costs in the last 12 months of life was AUD $99 077 (SD = $71 002) per patient. The total cost of the ACP programme in 2010/2011 was AUD $26 821. Conclusion Advance care planning was associated with improvements in end‐of‐life care preferences being known and adhered to for people with ESKD. Summary at a Glance Advance care planning (ACP) aims to empower patients, with the support of their caregivers, to consider their current and future treatment goals in the context of their own preferences and values. This study showed that ACP was associated with improvements in end‐of‐life care preferences being known and adhered to In addition, the average cost of providing ACP per‐patient was equal to 0.5% of the average hospital costs per‐patient in the last 12‐months of life.