title: The power of advance care planning in promoting hospice and out-of-hospital death in a dialysis unit.
abstract: 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.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A rural outpatient dialysis unit.
  
  
  METHODS
  Former dialysis patients who died over a 5-year period.
  
  
  METHODS
  Advance care planning, the use of physician orders for life-sustaining therapy program (POLST).
  
  
  METHODS
  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
  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.
authors.affiliation: 1 West Virginia University Schools of Medicine , Morgantown, West Virginia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Schmidt
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Weaner
authors.forename: Dustin
authors.initials: D
authors.lastname: Long
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data*