Association between advance care planning implementation and home deaths in visiting nurse agencies

Abstract Objective This secondary analysis of a nationwide survey examined the association between self-assessed advance care planning (ACP) implementation by visiting nurse agency (VNA) and home deaths among patients receiving end-of-life care. Results Of 369 VNAs analyzed, VNAs were classified into two groups: Home Death Predominant VNAs (more patients died at home than in hospitals) and Hospital Death Predominant VNAs (more patients died in hospitals than at home). ACP implementation was evaluated using 10 self-assessment items, with total scores categorized as high or low. Home Death Predominant VNAs had a significantly higher proportion of high scores (92.9%) than Hospital Death Predominant VNAs (86.1%, p = 0.04). Among the 10 ACP self-assessment items, six were significantly more often practiced in Home Death Predominant VNAs: understanding individual's values and life goals (p < 0.01), understanding individual's wishes regarding medical treatment and care (p = 0.03), appropriate explanation by a physician or other healthcare provider (p = 0.04), discussion with the individual, family members, and the healthcare team (p = 0.02), record-keeping of discussions (p = 0.03), and repeatedly discussing changes in individual's wishes (p = 0.04). These findings suggest that higher self-assessed ACP implementation is associated with a greater predominance of home deaths at the agency level.