Advance directives and real-world end-of-life clinical practice : a case-control study
Dalmau-Bueno, Albert (Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS))
Saura-Lazaro, A. (Institut Català d'Oncologia)
Busquets, J. M. (Generalitat de Catalunya. Departament de Salut)
Bullich-Marín, I. (Generalitat de Catalunya. Departament de Salut)
García-Altés, Anna (Institut d'Investigació Biomèdica Sant Pau)

Date:	2021
Abstract:	Background Advance directives (ADs) have been legally regulated to promote autonomy over health decisions among patients who later lose decision-making capacity. Aims and objectives To analyse the differences in clinical practice at end of life among people who had completed an AD versus those who had not. Methods Retrospective case-control study (1:2), matched by age, sex, year, cause of death and region of residence. The data sources used were the ADs registry, central registry of insured persons, hospital discharge, pharmacy and billing databases, and the mortality registry. Conditional logistic regression models (crude and adjusted by socioeconomic level) were performed. The outcome variable was the frequency of medical procedures performed during the last year of life. Results 1723 people with ADs who died in Catalonia during 2014-2015 were matched with 3446 dead controls (without ADs). Thoracentesis was the procedure with the greatest reduction among women with an AD (adjusted OR (OR adj) 0. 54, 95% CI: 0. 32 to 0. 89) in conjunction with artificial nutrition (OR adj 0. 54, 95% CI: 0. 31 to 0. 95). Intubation was the procedure with the greatest reduction (OR adj 0. 56, 95% CI: 0. 33 to 0. 94) among men. Slight differences could be seen in the case of cancer deaths. There were no relevant differences when adjusting by socioeconomic level. Conclusions ADs are an effective tool to adjust the realisation of some procedures at end of life. These results can help better plan for the treatment of patients with ADs, as well as increase the awareness among clinical personnel, families and the general population.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	BMJ Supportive and Palliative Care, Vol. 12 Núm. e3 (january 2021) , p. E337-E344, ISSN 2045-4368

DOI: 10.1136/bmjspcare-2020-002851
PMID: 33753359

8 p, 271.3 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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