Melissa M. Garrido|Tracy A. Balboni|Paul K. Maciejewski|Yuhua Bao|Holly G. Prigerson
Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives
James J. Peters VA Medical Center|Icahn School of Medicine at Mount Sinai|Dana-Farber Cancer Institute|Harvard University|Cornell University|Cornell University|Cornell University
contextadvance directives ads expected improve patients endoflife outcomes retrospective analyses surrogate recall patients preferences selection bias hampered efforts determine ads effects patient outcomesobjectivesthe aim examine associations among ads quality life estimated costs care week deathmethodswe used prospective data interviews 336 patients advanced cancer caregivers analyzed patient baseline interview caregiver provider postmortem evaluation data coping cancer study cost estimates healthcare cost utilization project nationwide inpatient sample published medicare payment rates cost estimates outcomes quality life range 010 estimated costs care received week death patient endoflife care preferences influence ad completion care use analyses stratified preferences regarding heroic endoflife measures everything possible remain aliveresultsmost patients want heroic measures 76 donotresuscitate dnr orders associated higher quality life 075 standard error 030 p 001 across entire sample statistically significant relationships dnr orders outcomes among patients stratified patient preference living willsdurable powers attorney outcomes patient groupsconclusionthe associations dnr orders better quality life week death indicate documenting preferences resuscitation medical orders may beneficial many patients