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

J Palliat Med. 2015 Jan;18(1):62-6. doi: 10.1089/jpm.2014.0031.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Advance Care Planning / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Female
  • Hospice Care / statistics & numerical data*
  • Hospital Mortality
  • Humans
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Renal Dialysis / statistics & numerical data*
  • Retrospective Studies
  • Rural Population / statistics & numerical data*
  • Terminal Care / organization & administration*
  • Terminal Care / statistics & numerical data*