Advance care planning (ACP) associated with reduced health care utilization in deceased older patients with advanced stage of chronic diseases

Abstract

© Journal Of The Medical Association Of Thailand. Objective: To investigate the prevalence of advance care planning (ACP) among cancer and non-cancer patients in the advanced stages of their illnesses and to explore the association of ACP and health care utilization. Materials and Methods: A retrospective review of patients aged 60 years or more who were admitted and died during the year 2013 was conducted. The cases with advanced diseases were selected and categorized into cancer and non-cancer groups. Any discussion regarding planning for preferred treatments and procedures to be delivered in the event of critical illness was defined as ACP. Comparisons were performed between patients with and without documented ACP. Results: There were 279 cancer and 381 non-cancer patients. The prevalence of documented ACP among the cancer and noncancer patients were 60.6% and 35.7%, respectively (p<0.001). For both groups, ACP resulted in lower median length of hospital stay (p<0.001), lower rates of performing invasive procedures (p<0.001), and lower total costs of care (p<0.001). Conclusion: ACP was not carried out for a substantial proportion of older patients in the advanced stages of their illnesses, especially among non-cancer patients. Implementing ACP at the optimal time for older patients, particularly in the case of non-cancer patients, might improve their quality of care, diminish the utilization of unnecessary procedures, and lower the total costs of care.