Patients and their families, scholars, and policy makers question the ability of our “high tech” health care system to provide the end-of-life care patients prefer, be it the “heroic, nothing held back” type of care that some need and desire, or the palliative “low tech, and emotionally supportive” care that may be preferred and is more appropriate in some situations. To investigate the role of individual versus program/provider characteristics in influencing end-of-life care, we studied the factors predicting the use of 3 types of advance directives -- resuscitation orders, designation of a health proxy, and artificial feeding -- among 3,548 PACE enrollees in 9 sites. Results confirm findings in prior studies of the importance of specific individual characteristics in influencing the use of advance directives (e.g. age, gender and race). However, even after controlling for a large number of individual characteristics (socio-economic and health related factors), the variation in probabilities of advance directives across sites was substantial and statistically significant. For do not resuscitate code (DNR), it ranged from a low of 12% of patients to a high of 83%. For health proxy it ranged from 17% to 82%, and for tube feeding, from 11% to 65%. These findings suggest that providers of care play an important role in use of advance directives and that policies and interventions designed to influence end of life practices should target both patients and providers.
Learning Objectives: 1. Particpants will be able to describe the experience with respect to advance directives in the PACE program. 2. Particpants will gain an understanding of the factors that influence use of advance directives.
Keywords: Elderly,
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.