Integrative Palliative Care, Advance Directives, and Hospital Outcomes of Critically Ill Older Adults

Abstract

Significantly lower hospital costs and in-hospital deaths with higher hospice discharges were observed in integrative palliative care compared to consultative palliative care, but these findings were diminished with the presence of advance directives.

The economic evidence for advance care planning: Systematic review of evidence

“…These evaluate different types of ACP intervention in a variety of settings, including nursing homes , hospitals Teno et al, 1997), a home-based telephone counselling intervention ) and a complex care and coordination programme delivered through Veteran Affairs medical centers . The remaining studies are observational; three non-randomised controlled designs Baker et al, 2012 andYoo et al, 2012) and ten natural experiments.…”

“…Eight of the studies include community-based as well as hospital costs Nicholas et al, 2014;Nicholas et al, 2011;Kelley et al, 2011;Hamlet et al, 2010;Gade et al, 2008Kessler and McClellan, 2004), although, the range of included services varies and it is often unclear whether all possible healthcare services are covered. Ten of the studies include only, or primarily, hospital costs (Abel et al, 2013;Lukas et al, 2013;Baker et al, 2012;Tan and Jatoi, 2011;Yoo et al, 2012;Molloy et al, 2000;Teno et al, 1997;Weeks et al, 1994;Chambers et al, 1994). Since reduced inpatient hospital care is likely to require substitution with community-based health and palliative care services (Yu et al, 2014;Kinley et al 2014;Social Care Institute for Excellence, 2013;Emanuel and Emanuel, 1994), studies that focus only on hospital costs will fail to identify changes to these wider service costs.…”

“…Three studies use data from the US Health and Retirement Study, with its nationally representative sample of older people Nicholas et al, 2011;Kelley et al, 2011), while Kessler and McClellan (2004) use a large random sample of Medicare beneficiaries. The remaining studies use selective samples, defined either by patient characteristics, for example, high-cost and low-income Medicare beneficiaries , or by care setting, with seven of the studies based on hospital samples (Yoo et al, 2012;Tan and Jatoi, 2011;Zhang et al, 2008;Gade et al, 2008;Teno et al, 1997;Chambers et al, 1994). Some studies use samples defined by both patient characteristics and care setting, for example, patients admitted to an inpatient oncology unit in a US hospital (Tan and Jatoi, 2011).…”

“…Kelley et al (2011) Nicholas et al, 2011). Other observational studies control for a similar range of demographic and risk-related variables (Teo et al, 2012;Yoo et al, 2012;Tan and Jatoi, 2011;Weeks et al, 1994;Chambers et al, 1994). In the UK, Baker et al (2012) selected intervention and control groups using a predictive model for identifying those at risk of hospitalisation.…”

Facilitators and Barriers to Use of Advance Directives in Korea

“…2,5,[9][10][11] One strategy that can spare the burden of unnecessary physical, emotional, and financial suffering on individuals and society and stress with regard to decision making at the end of life is the use of advance directives (ADs). 3,9,12 An AD is a legal document that enables an individual to state one's treatment preferences ahead of time and/or appoint a surrogate to make decisions at the end of life when one is incapable of making health care choices. 3,5,9/11 With respect for autonomy in health care choices, ADs prevent unwanted or futile life-sustaining treatments against an individual's wishes, thereby promoting quality of end of life.…”