DEATH AND END-OF-LIFE PLANNING IN ONE MIDWESTERN COMMUNITY

Background: The major health care organizations in a geographically de fined area implemented an extensive, collaborative advance directive e ducation program approximately 2 years prior to this study. Objectives : To determine for a geographically defined population the prevalence and type of end-of-life planning and the relationship between end-of-l ife plans and decisions in all local health care organizations, includ ing hospitals, medical clinics, long-term care facilities, home health agencies, hospices, and the county health department. Methods: For mo re than 11 months, end-of-life planning and decisions were retrospecti vely studied for all adult decedents residing in areas within 5 ZIP co des. These decedents were mentally capable in the 10 years prior to de ath and died while under the care of the participating health care org anizations. Data were collected from medical records and death certifi cates. Treating physicians and decedent proxies were also contacted fo r interviews. Results: A total of 540 decedents were included in this study. The prevalence of written advance directives was 85%. Almost al l these documents (95%) were in the decedent's medical record. The med ian time between advance directive documentation and death was 1.2 yea rs. Almost all advance directive documents requested that treatment be forgone as death neared. Treatment was forgone in 98% of the deaths. Treatment preferences expressed in advance directives seemed to be con sistently followed while making end-of-life decisions. Conclusions: Th is study provides a more complete picture of death, end-of-life planni ng, and decision making in a geographic area where an extensive advanc e directive education program exists. It indicates that advance planni ng can be prevalent and can effectively guide end-of-life decisions.