Death and end-of-life planning in one midwestern community

Area of Science:

• Gerontology
• Public Health
• Bioethics

Background:

• A collaborative advance directive education program was implemented by major healthcare organizations in a defined geographic area.
• The program was initiated approximately two years before this retrospective study.

Purpose of the Study:

• To assess the prevalence and types of end-of-life planning within a defined population.
• To examine the relationship between end-of-life plans and decisions across various local healthcare organizations.

Main Methods:

• Retrospective study of end-of-life planning and decisions for adult decedents over 11 months.
• Data collected from medical records, death certificates, physician interviews, and proxy interviews.
• Study focused on mentally capable decedents within a 5 ZIP code area over the 10 years prior to death.

Main Results:

• 85% of 540 decedents had written advance directives, with 95% in their medical records.
• Median time from documentation to death was 1.2 years; most directives requested forgoing treatment near death.
• Treatment was forgone in 98% of deaths, and documented preferences were consistently followed.

Conclusions:

• Extensive advance directive education can lead to prevalent and effective end-of-life planning.
• Advance planning demonstrably guides end-of-life decision-making in a community setting.