Marcus Sellars1,2, Rachael L Morton3, Josephine M Clayton1,4, Allison Tong5,6, Daveena Mawren2, William Silvester2, David Power7, Ronald Ma8, Karen M Detering1,9. 1. Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia. 2. Advance Care Planning Australia, Austin Health, Melbourne, Victoria, Australia. 3. NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia. 4. HammondCare Palliative & Supportive Care Service, Greenwich Hospital, New South Wales, Australia. 5. Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. 6. Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia. 7. Department of Nephrology, Austin Health, Melbourne, Victoria, Australia. 8. Clinical Costing, Austin Health, Melbourne, Victoria, Australia. 9. Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia.
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 $26 821. CONCLUSION: Advance care planning was associated with improvements in end-of-life care preferences being known and adhered to for people with ESKD.
AIM: The aim of the present study was to examine the efficacy of advance care planning (ACP) to improve the likelihood that end-stage kidney disease (ESKD) patient's preferences will be known and adhered to at end-of-life. METHODS: A case-control study of a nurse-led ACP programme in adults with ESKD from a major tertiary hospital. The primary outcome was the proportion of patients whose preferences were known (by substitute decision maker and/or clinicians) and adhered to by their treating doctors. Secondary measures were health system resource use and costs ($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.
Authors: Manjula Kurella Tamura; Laura Holdsworth; Margaret Stedman; Annette Aldous; Steven M Asch; Jialin Han; Glenda Harbert; Karl A Lorenz; Elizabeth Malcolm; Amanda Nicklas; Alvin H Moss; Dale E Lupu Journal: Clin J Am Soc Nephrol Date: 2022-09-14 Impact factor: 10.614
Authors: Marcus Sellars; Josephine M Clayton; Karen M Detering; Allison Tong; David Power; Rachael L Morton Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240