Only 22% of Americans Have Documented End-of-Life Wishes

A majority of people in the United States know the types of end-of-life care they wish to receive, but only 22% have documented their wishes.

Significant variations in advance care planning utilization also exist among racial and ethnic groups. About 25% of those who have documented their wishes are white. African Americans represented 22%, Hispanics 21% and Asians 7%.

These data follow a recent study by NORC at the University of Chicago showing that hospice generally improves clinical outcomes and pain management, as well as physical and emotional distress compared to those who decline palliative care. VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE), commissioned the national survey.


Many Americans understand the importance of end-of-life planning but don’t follow through with the documentation, according to Dr. Joseph Shega, executive vice president and chief medical officer at VITAS. 

“Advance care planning is something that can benefit all people. Unfortunately, there is a gap between thinking about end-of-life planning and actually documenting those wishes,” Shega said in a statement. “I can’t stress enough how valuable advance care planning is for all Americans. It allows patients to make their preferences known early and is useful as they become seriously ill and enter advanced disease stages.”

Other disparities in utilization persist. Nearly half of African Americans do not know the type of end-of-life care they would choose, and 10% have no plans to document their wishes.


A significant contingent of Black, Asian and Hispanic respondents also indicated that current events have influenced whether or not they would document their end-of-life care decisions.

The study was published in advance of National Health Care Decisions Day, observed annually on April 16.

The research also found that — although overall 49% of respondents said they know where to find information about advance care planning — one-third of those who identified as Asian indicated that they did not know where to turn.

A majority of respondents also said that they believe end-of-life planning should begin in their 50s, yet people of color tended to say it should start in their 30s or 40s.

“Knowing a patient’s wishes for end of life ensures care aligns with their goals and values,” Shega said. “It also relieves the burden on families to make critical medical decisions on behalf of their loved ones.”

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