The power of advance care planning in promoting hospice and out-of-hospital death in a dialysis unit

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Background: Despite mortality rates that exceed those of most cancers, hospice remains underutilized in patients with end-stage renal disease (ESRD) on dialysis and nearly half of all dialysis patients die in the hospital. Objective: To review the impact of advance care planning on withdrawal from dialysis, use of hospice, and location of death. Design: Retrospective review. Setting: A rural outpatient dialysis unit. Participants: Former dialysis patients who died over a 5-year period. Exposure: Advance care planning, the use of physician orders for life-sustaining therapy program (POLST). Main Outcome and Measure: Use of hospice among patients withdrawing from dialysis, location of death. Results: Advance care planning was associated with a low incidence of in-hospital death and among those who withdrew, a high use of hospice. Conclusions and Relevance: Comprehensive and systematic advance care planning among patients with ESRD on dialysis promotes greater hospice utilization and may facilitate the chance that death will occur out of hospital.