Advance Care Planning Associated with Longer Survival at End of Life

Advance care planning is associated with longer life among terminally ill patients, a recent study in BMJ Supportive and Palliative Care found. 

Through advance care planning, patients make clear their wishes and goals for end-of-life care and communicate that information to their clinicians as well as their families. Advance care plans also typically include the patient’s designated surrogate who can make health care decisions in their stead should the patient become incapacited.

Researchers recorded the dates of death for 205 terminally ill patients; 102 of those patients had had a conversation about their end-of-life wishes and intentions with a physician, and 103 had not. Around half the patients in each of the groups had advanced cancer, and half had been terminally ill with heart and lung conditions.

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“[Advance care planning] was associated with a significantly improved survival among terminally ill patients, primarily [those] with non-cancer diseases. However, the analysis was explorative, and the association must be investigated further before drawing any firm conclusion,” the researchers concluded.

Additional analysis of these data show a difference in survival after a year of monitoring between those who had had this type of conversation and those who hadn’t.

Nearly three out of four of those (73%) of those who had done so were alive after a year compared with more than half (57%) of those who hadn’t.

While researchers observed no significant difference in survival between terminally ill cancer patients who had or hadn’t had an advance care planning conversation, such correlations did exist among those with other types of terminal illness, the analysis showed.

Among this group, 90% of those who had done so were alive after a year, compared with 67% of those who hadn’t.

Additional studies show that advance care planning can reduce hospitalizations by as much as 26%, reduce health care costs, increase community-based palliative care and hospice utilization, as well as significantly increase the likelihood that care will be delivered in accordance with the patient’s wishes.

Despite the benefits of advance care planning, many patients don’t pursue it or pursue it too late. Only 14% of patients with serious illnesses have advance care plans. Patients who choose to receive palliative care are the most likely to have a plan.