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Evidence & Research: End-of-Life Care Innovation and the Impact of Advance Care Planning

Research shows that individuals with advanced illness who receive advance care planning services are more likely to have conversations about their end- of- life care wishes and more likely to document their preferences in advance directives — increasing their likelihood of receiving care consistent with their preferences at the end of life.

The care they choose tends to favor palliation over aggressive measures; as a result, they are less likely to die in a hospital or ICU or to have a feeding tube or ventilator in the last month of life and more likely to receive hospice and/or palliative care. These forms of care, in turn, are associated with better quality of life and greater satisfaction with the care they receive.

Advance care planning also is associated with greater alignment between patients and caregivers regarding end-of-life care choices, resulting in lower decisional burden, higher caregiver satisfaction with care, and better adjustment among bereaved caregivers.[i]

Colaberdino, Marshall, DuBose, and Daitz (2016) found that medical costs for decedents who received our services were significantly lower in the final three and final six months of life than otherwise similar control decedents.

Brubaker, Cardillo, & Zuckoff (2020, March) reported that Medicare Advantage health plan members who received our services had 22.5% fewer inpatient admissions and 18.1% fewer ER visits, and were 3.6 times more likely to elect hospice care, compared with case matched controls.

The Clinical Excellence Research Center at the Stanford University School of Medicine identified the Vital Decisions model as one of three care delivery innovations that could serve as pillars of an evidence-based approach to  better meeting the needs of older adults and reducing per capita spending (Rinaldo et al., 2017).[ii]

National guidelines recommend that end of life care discussions take place early in the illness trajectory and during periods of relative medical stability, and that plans should be routinely reviewed when changes in the patient’s condition or transitions of care occur. However, studies show that the first advance care planning conversation most often happens during the last month of life, often during inpatient episodes and acute crises. The time pressure created by conducting these conversations in these circumstances frequently reduces their effectiveness. At this point it’s often too late for a meaningful impact on the treatment experience, and optimal decision-making by patient and family is no longer possible. Unsurprisingly, this all too often results in excessive and unwanted aggressive treatment during the last days of life. [iii]