A new study in the Journal of the American Medical Association finds that when Medicare beneficiaries make their end-of-life preferences clear, it reduces spending, lowers one's likelihood of dying in a hospital, and increases the use of hospice care.' The study also found that in regions where health care spending was already high, end-of-life care for patients with advance directives cost less than for patients who didn't have them.' Alex Smith, M.D. offers his commentary on the study at the GeriPal blog, pointing out that advance directives help health care proxies make "in-the-moment decisions."
A review in the American Journal of Nursing finds that conversations like these especially benefit patients with implanted cardioverter defibrillators (ICDs).' Near the end of life, ICDs, which are meant to correct irregular heart rhythm, "may generate repeated painful shocks during a patient's final hours, at a time when the natural process of dying often affects the heart's rhythm."' And although ICDs are a common form of treatment for people with heart arrhythmias, it is uncommon for clinicians to discuss with patients the likelihood of these painful shocks.' Jim Russo, the study author and a certified cardiac device specialist, suggests that health care systems should 'identify ways to promote timely deactivation discussions and thus foster better patient-centered, end-of-life care in people with ICDs."
In the Prepared Patient feature article Advance Directives: Caring For You and Your Family you can find resources to help you decide what end-of-life plans are right for you, how to complete the appropriate forms, and the best ways to distribute and talk about them.' In Prepared Patient: Hospice Care: What is it, Anyway?, the difference between hospice and palliative care options are explained, along with other helpful information like what hospice nurses do at a home visit.