Advance Care Planning Affects Caregivers and Care Costs

According to a report by HospiceNews.com, services known as advance care planning (ACP) not only can improve caregiver satisfaction but also reduce health care costs at the end of life. Quoting Dr. Simeon Kwan, a palliative care physician, HospiceNews said families with access to ACP services often experience less distress in the final stages of a loved one’s life and spend less time and money on expensive emergency care that a patient in many cases might not want. Dr. Kwan said that when end-of-life wishes are discussed ahead of time, “then our caregivers can feel more empowered to make the right decisions their loved ones would have wanted in a less stressful manner in what can feel like a time of chaos.” This can prevent unnecessary emergency room use and hospitalizations and can even increase the median length of stays on hospice. However, a large proportion of families nationwide have not held advance care planning discussions. In one JAMA Health Forum study, only about 11% of more than 950,000 Medicare decedents who died between 2017 and 2018 had utilized such services. Dr. Delia Chiaramonte, another palliative physician, was quoted as saying it is a “horrific situation for family members” and causes emotional suffering to have to make a decision without that guidance or idea of what their loved one would want. Dr. Chiaramonte added that “Making these decisions in concert with the person takes away so much of that burden and angst. It helps a person die with dignity, maintain control, [and] can significantly reduce people’s physical, emotional, and spiritual suffering.” She insisted that understanding whether a patient wishes to have more aggressive versus less intensive care as their illness progresses is a core piece of health care quality. HospiceNews also noted the JAMA study found that ACP was associated with significantly less intensive care use at the end of life, lower rates of hospital and ICU admissions, lower rates of in-hospital deaths, and lower rates of late hospice referrals.