BMJ Support Palliat Care doi:10.1136/bmjspcare-2012-000327
  • Research

The impact of advance care planning of place of death, a hospice retrospective cohort study

Open Access
  1. Julia Verne2
  1. 1Weston Area Health Trust and Weston Hospicecare, Weston super Mare, UK
  2. 2South West Public Health Observatory, Bristol, UK
  1. Correspondence to Dr Julian Abel, Consultant in Palliative Care, Weston Area Health Trust, Grange Rd, Weston super Mare, BS23 4TQ, UK; julian.abel{at}{at}


Objectives There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year.

Results 969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group(p<0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p<0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p<0.001).

Conclusions ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008.

  • Received 12 July 2012.
  • Revision received 29 January 2013.
  • Accepted 8 February 2013.
  • Published Online First 14 March 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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