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    Advance Directives Shape End-of-Life Experiences

    Study Shows Living Wills May Also Help Reduce Health Care Costs

    Advance Directives Eliminate Guess Work continued...

    "Physicians were making efforts to provide feeding tubes or resuscitation when it could help, but they did make a more rapid recognition of when these measures were no longer effective among people who had a living will," Nicholas says.

    "You don't get less treatment if you have an advance directive," she says. "An advance directive can make the difference between dying in a hospital and dying in a comfort care setting such as your own home."

    Curbing Health Care Costs

    In regions of the U.S. where end-of-life spending is greatest, advance directives helped reduce costs. Cost of caring for people with living wills who stated that they did not want aggressive measures taken to keep them alive was $33,933.

    By comparison, if a person did not have an advance directive, the cost of care during their last six months was $39, 8517. This difference was only seen in "high-spending" regions.

    "At large academic medical centers, there are lots of specialists and there is a treatment-speeding train, and the doctors don't always engage patients and family in the treatment decisions," says Nancy D. Zionts, MBA. She is chief program officer of Jewish Healthcare Foundation in Pittsburgh, a nonprofit group that focuses on end-of-life and other health care issues.

    "The conversation that takes place should be about where you want to die, whether or not you want additional treatments, and/or whether they want to be taken to the hospital if there is a change in their terminal condition," she says. "You can say 'I want everything' as easily as 'I want less,'" she says.

    Other issues that should be addressed include pain management and what friends or family members you do, or don't, want around, she says.

    It's also important that doctors are on board, she says. Some states are adopting a program called Polst -- Physician Orders for Life-Sustaining Treatment -- in which doctors sign off on advance directives.

    "These will be game changers," she says.

    Porter Storey, MD, is the executive vice president of the American Academy of Hospice and Palliative Medicine. He says that hospices and palliative care services are responsible for the differences in the end-of-life experience -- not the advance directive, per se.

    "People who don't want to die on a ventilator and would rather spend their last days at home are using hospice and palliative care services," he says. "Part of a palliative care team's job is getting the advance directive done and making sure you get the services that line up with what you want, which may be hospice care," he says. Storey practices palliative care in Lafayatte, Colo.

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