Advance Care Planning Documentation Completeness and End-of-Life Care: Trends and Associations Using HRS 2010-2022...

Area of Science:

• Gerontology
• Public Health
• Medical Ethics

Background:

• Advance care planning (ACP) documentation enables individuals to express medical care preferences and appoint decision-makers.
• The specific benefits of comprehensive ACP documentation remain unclear.

Purpose of the Study:

• To investigate the additive associations between comprehensive ACP documentation and end-of-life (EOL) care outcomes in older US adults.

Main Methods:

• Utilized Health and Retirement Study exit interview data (2010-2022) from 5622 decedents.
• Operationalized ACP documentation as none, one document (living will or durable power of attorney), or two documents.
• Analyzed EOL outcomes including ICU use, life-sustaining treatments, hospice utilization, and place of death.

Main Results:

• Having any ACP documentation was associated with reduced use of life-sustaining treatments and increased hospice utilization and out-of-hospital deaths.
• Comprehensive documentation showed similar patterns, with modest incremental benefits.
• Associations were more pronounced in decedents with expected deaths.

Conclusions:

• ACP documentation is associated with less aggressive EOL care and greater hospice utilization.
• The incremental benefits of having two ACP documents are modest.
• ACP's impact on EOL care varies based on the predictability of death.