Martina Orlovic1, Haider Warraich2, Douglas Wolf3, Elias Mossialos4. 1. Imperial College London (M.O., E.M.), Department of Surgery and Cancer, London, UK. Electronic address: m.orlovic15@imperial.ac.uk. 2. Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School (H.W.), Boston, Massachusetts, USA; Department of Medicine, Cardiology Section, VA Boston Healthcare System (H.W.), Boston, Massachusetts, USA. 3. Department of Public Administration and International Affairs, Syracuse University (D.W.), Syracuse, New York, USA. 4. Imperial College London (M.O., E.M.), Department of Surgery and Cancer, London, UK; London School of Economics and Political Science (E.M.), Department of Health Policy, London, UK.
Abstract
CONTEXT: Americans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care. OBJECTIVE: To examine determinants of end-of-life planning; including, the effect of an individual's ageing and dying process, health status and socio-economic and racial/ethnic background. METHODS: US observational cohort study, using data from the Health and Retirement Study (1992 - 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics. RESULTS: End-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient's proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging. CONCLUSIONS: Understanding differences that increase end-of-life planning is important to incentivize patients' participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.
CONTEXT: Americans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care. OBJECTIVE: To examine determinants of end-of-life planning; including, the effect of an individual's ageing and dying process, health status and socio-economic and racial/ethnic background. METHODS: US observational cohort study, using data from the Health and Retirement Study (1992 - 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics. RESULTS: End-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient's proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging. CONCLUSIONS: Understanding differences that increase end-of-life planning is important to incentivize patients' participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.
Authors: Alexi A Wright; Nancy L Keating; John Z Ayanian; Elizabeth A Chrischilles; Katherine L Kahn; Christine S Ritchie; Jane C Weeks; Craig C Earle; Mary B Landrum Journal: JAMA Date: 2016-01-19 Impact factor: 56.272
Authors: Terri R Fried; Colleen A Redding; Mark L Robbins; Andrea Paiva; John R O'Leary; Lynne Iannone Journal: J Am Geriatr Soc Date: 2010-12 Impact factor: 5.562
Authors: Avni Gupta; Ginger Jin; Amanda Reich; Holly G Prigerson; Keren Ladin; Dae Kim; Deepshikha Charan Ashana; Zara Cooper; Scott D Halpern; Joel S Weissman Journal: J Am Geriatr Soc Date: 2020-08-27 Impact factor: 5.562