End-of-life discussions as a component of advance care planning and their associations with care received near death

Background: Advance care planning (ACP) is an ongoing process of communication of end-of-life (EOL) preferences between patients, families, and health care professionals (HCPs). ACP includes having EOL discussions, durable power of attorney for health care (DPAHC), and living will (LW). Engagement in DPAHC and LW can lead to less aggressive treatments and more comfort care, but little is known about the effects of EOL discussions of patients’ preferences on their outcomes. Purposes: The purposes of this study were: 1) to examine patient characteristics influencing engagement in ACP; 2) to determine the effect of engagement in EOL discussions alone and the combined effect of EOL discussions with DPAHC and/or LW on EOL care; and 3) to examine the effect of EOL discussions and DPAHC on congruency between patients' preferences for care and care they received. Method(s): This study was a secondary data analysis using the Health and Retirement Study Exit Interviews of 6,001 decedents aged 50 years or older. Five different types of engagement in ACP were selected for this study. Sequential logistic regression and multivariable logistic regression were used. Results: Decedent characteristics significantly associated with engagement in ACP were different by the types of engagement. Engagement in EOL discussions only was not a predictor of receiving all possible care to prolong life but was a predictor of receiving comfort care. Engagement in all three types of ACP was the strongest predictor of receiving both all possible care to prolong life and comfort care. Among decedents who had a LW, there was a synergistic effect of engagement in EOL discussions and DPAHC on receiving care consistent with decedents' preferences for EOL care. Engaging in more types of ACP was associated with lower odds of receiving all possible care, higher odds of receiving comfort care, and higher odds of receiving care consistent with decedents’ preferences. Conclusions: Findings suggests that there was a synergistic effect of engagement in EOL discussions, DPAHC, and LW on receiving EOL care. HCPs should make more effort to communicate with patients and their families about their preferences at the EOL