A case-control study of end-of-life treatment preferences and costs following advance care planning for adults with end stage kidney disease.

Abstract

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. A case-control study of a nurse-led ACP program 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. 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 program in 2010/11 was AUD $26,821. ACP was associated with improvements in end-of-life care preferences known and adhered to for people with ESKD.