Advance care planning (ACP) enables patients with chronic life limiting illnesses to discuss about future care preferences in the event of them losing mental capacity. Preferred place of dying (PPOD) during final hours forms an important component in ACP discussion. Evaluation of actual care concordance to documented preferences can help to determine the effectiveness of ACP. This study aimed to examine the concordance between preferred and actual place of dying for patients with end stage renal disease (ESRD) on conservative care (CC).
This retrospective observational study reviewed subjects with ESRD on CC who were referred to palliative service in a tertiary hospital in Malaysia between January 2016 and December 2017. The concordance between documented PPOD and actual place of death was explored using Chi-square test.
A total of 156 patients with ESRD referred to palliative service passed away during the 2-year period. The median survival was 77 days (IQR 175) for patients on conservative care. Approximately half were referred to community hospice (48.7%). ACP discussion was documented for 95.5% of patients. Only about one third (37.8%) had expressed PPOD, with almost equivalent preference for home and hospital. About three-fifth of patients died in hospital (60.3%), while the remaining passed away at home (30.7%). The chance of home death for patients with undocumented PPOD was 35.1%. Patients who expressed home as PPOD were significantly more likely to spend their final hours at home than those with undocumented PPOD (p< 0.001). Support from community hospice team also contributed significantly in enabling a home death (p< 0.001).
Patients who preferred to spend final hours at home were more likely to have their wishes honoured if PPOD was discussed and documented during ACP discussion. Community hospice also played a significant role in enabling dying at home for patients with ESRD on CC.
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