Evidence map›Paper›PMID 31150504›Full record

ArticlePloS one2019

Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis.

Marcus Sellars, Josephine M Clayton, Karen M Detering, Allison Tong, David Power, Rachael L Morton

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06046261 (Exploring the Impact of " ACP Board Game for Life" on Death Preparation and Anxiety in Patients With Stage 4 and 5 Chronic Kidney Diseases), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
3.8field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06046261 nacompletednot on this mapstarted 2022, after this paper: background citation

Exploring the Impact of " ACP Board Game for Life" on Death Preparation and Anxiety in Patients With Stage 4 and 5 Chronic Kidney Diseases: A Pilot Study

TypeinterventionalSponsorNational Cheng-Kung University HospitalRan2022 to 2023Enrolled69ConditionsChronic Kidney Disease, Chronic Renal Failure, Chronic Renal Insufficiency, End of Life CareArmsACP board game for life
3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Marcus SellarsKolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia.ORCID 0000-0002-8299-0313
Josephine M ClaytonKolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia.
Karen M DeteringAdvance Care Planning Australia, Austin Health, Melbourne, Australia.
Allison TongSydney School of Public Health, The University of Sydney, Sydney, Australia.
David PowerDepartment of Nephrology, Austin Health, Melbourne, Australia.
Rachael L MortonNHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.ORCID 0000-0001-7834-0572
The University of Sydney · AUAustin Health · AUThe University of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEconomic evaluations of advance care planning (ACP) in people with chronic kidney disease are scarce. However, past studies suggest ACP may reduce healthcare costs in other settings. We aimed to examine hospital costs and outcomes of a nurse-led ACP intervention compared with usual care in the last 12 months of life for older people with end-stage kidney disease managed with haemodialysis.

methodsWe simulated the natural history of decedents on dialysis, using hospital data, and modelled the effect of nurse-led ACP on end-of-life care. Outcomes were assessed in terms of patients' end-of-life treatment preferences being met or not, and costs included all hospital-based care. Model inputs were obtained from a prospective ACP cohort study among dialysis patients; renal registries and the published literature. Cost-effectiveness of ACP was assessed by calculating an incremental cost-effectiveness ratio (ICER), expressed in dollars per additional case of end-of-life preferences being met. Robustness of model results was tested through sensitivity analyses.

resultsThe mean cost of ACP was AUD$519 per patient. The mean hospital costs of care in last 12 months of life were $100,579 for those who received ACP versus $87,282 for those who did not. The proportion of patients in the model who received end-of-life care according to their preferences was higher in the ACP group compared with usual care (68% vs. 24%). The incremental cost per additional case of end-of-life preferences being met was $28,421. The greatest influence on the cost-effectiveness of ACP was the probability of dying in hospital following dialysis withdrawal, and costs of acute care.

conclusionOur model suggests nurse-led ACP leads to receipt of patient preferences for end-of-life care, but at an increased cost.

Indexed as

Cost-Benefit AnalysisDecision MakingAdvance Care PlanningAgedAged, 80 and overDecision Support TechniquesFemaleHealth Care CostsHospital CostsHumansKidney Failure, ChronicMaleMiddle AgedPatient PreferenceQuality of LifeRenal Dialysis

Identifiers

PMID31150504
PMCPMC6544277
OpenAlexW2947844822

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.