title: The impact of advance care planning of place of death, a hospice retrospective cohort study.
abstract: OBJECTIVE
  There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year.
  
  
  RESULTS
  969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group(p<0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p<0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p<0.001).
  
  
  CONCLUSIONS
  ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008.
authors.affiliation: Weston Area Health Trust and Weston Hospicecare, Weston super Mare, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Abel
authors.forename: Andy
authors.initials: A
authors.lastname: Pring
authors.forename: Alison
authors.initials: A
authors.lastname: Rich
authors.forename: Tariq
authors.initials: T
authors.lastname: Malik
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000191:economics / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003643:Death; D004739:England; D005260:Female; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006738:Hospices / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013727:Terminal Care
keywords: Cancer; Chronic conditions; Communication; Hospice care; Service evaluation