Abstract Details

Title The Association Between Life-prolonging Treatment Preferences and End-of-life Experiences

Topic Palliative Care

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 11-009

Objective We aimed to explore the association between life-prolonging treatment(LPT) preferences and healthcare utilization and patient experience at the end of life(EOL).

Background People markedly differ in their preferences for care. Decision makers for people, especially for those experienced severe acute brain injury, often face decisions about LPT. Yet, little is known about the association between LPT preference and EOL care.

Design/Methods We identified 1010 respondents in the National Health and Aging Trends Study(NHATS)-CMS linked dataset who died between 2003-2021, responded to the NHATS EOL LPT preference and last month of life modules and had linked Medicare claims. We used logistic regression analyses to examine the association between LPT preferences and patient-centered outcomes(place of death, quality of EOL care, alertness, and whether they were able to get out of bed in the last month of life), Cox regressions for hospice services, and Poisson regressions for healthcare utilization(ICU stay and receipt of LPT in the last year of life), adjusting for sociodemographic and comorbidities.

Results

Respondents were average of 81.6 years old(SD7.9), 7.9% Black race, 53% female, 20% had a history of stroke, 22% had dementia, and 41% had cancer. 26.8% of respondents preferred LPT, who were more likely to be male, Black, have less than high school education, and married. Compared with respondents against LPT, those who preferred LPT were more likely to die in the hospital(OR 1.47, 95%CI:1-2.15, p=0.049) and less likely to use hospice(HR 0.78 95%CI:0.62-0.998, p=0.048). There was no association between LPT preferences and the quality of EOL care, alertness, getting out of bed, number of ICU stays, and receipt of LPT.

Conclusions

Older adults who preferred LPT were more likely to die in the hospital and less likely to use hospice. Understanding these associations could inform future strategies to promote value-concordant EOL care, especially for people with acute severe brain injury.

Authors/Disclosures
Chun Chieh Lin, PhD (The Ohio state University) PRESENTER	The institution of Dr. Lin has received research support from AAN. The institution of Dr. Lin has received research support from Genentech Inc. The institution of Dr. Lin has received research support from NIH.
Ran Bi, MS (The Ohio State University)	Miss Bi has nothing to disclose.
James F. Burke, MD (Ohio State Wexner Medical Center)	Dr. Burke has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association/Circulation: Cardiovascular quality and outcomes. The institution of Dr. Burke has received research support from Genentech Foundation. The institution of Dr. Burke has received research support from NIH.
Lesli E. Skolarus, MD, MS (Northwestern University)	The institution of Dr. Skolarus has received research support from NIH.

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