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.