{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:38:41Z","timestamp":1786372721698,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and\/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death. Among patients receiving dialysis, we linked the content of advance directives to Medicare claims to ascertain site of death and treatment intensity in the last month of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the last year of life, 36% of nursing home residents receiving dialysis had a treatment-limiting directive, 22% had a surrogate decision-maker, and 13% had both in adjusted analyses. These estimates were 13%\u201327%, 5%\u201311%, and 6%\u201313% lower, respectively, than for decedents with other serious illnesses. For patients receiving dialysis who had both a treatment-limiting directive and surrogate decision-maker, the adjusted frequency of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13%, and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients receiving dialysis lacking both components.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among nursing home residents receiving dialysis, treatment-limiting directives and surrogates were associated with fewer intensive interventions and inpatient deaths, but were in place much less often than for nursing home residents with other serious illnesses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.07510716","type":"journal-article","created":{"date-parts":[[2017,1,5]],"date-time":"2017-01-05T21:00:30Z","timestamp":1483650030000},"page":"435-442","source":"Crossref","is-referenced-by-count":47,"title":["Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis"],"prefix":"10.2215","volume":"12","author":[{"given":"Manjula","family":"Kurella Tamura","sequence":"first","affiliation":[{"name":"Geriatric Research and Education Clinical Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, California;"},{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Montez-Rath","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshio N.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Medicine, Group Health Cooperative, Seattle, Washington;"},{"name":"Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Group Health Cooperative, Seattle, Washington;"},{"name":"Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"O\u2019Hare","sequence":"additional","affiliation":[{"name":"Department of Medicine, Group Health Cooperative, Seattle, Washington;"},{"name":"Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington; and"},{"name":"Department of Hospital and Specialty Medicine, Veteran Affairs Puget Sound Health Care System, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,1,5]]},"reference":[{"issue":"Suppl 1","key":"B1-20230813","first-page":"S1","article-title":"US Renal Data System 2014 Annual Data Report: Epidemiology of kidney disease in the United States.","volume":"66","author":"Saran","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1001\/jamainternmed.2013.6036","article-title":"Relationship between the prognostic expectations of seriously ill patients undergoing hemodialysis and their nephrologists.","volume":"173","author":"Wachterman","year":"2013","journal-title":"JAMA Intern Med"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1111\/j.1532-5415.2012.03917.x","article-title":"Effect of a disease-specific advance care planning intervention on end-of-life care.","volume":"60","author":"Kirchhoff","year":"2012","journal-title":"J Am Geriatr Soc"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2215\/CJN.05960809","article-title":"End-of-life care preferences and needs: Perceptions of patients with chronic kidney disease.","volume":"5","author":"Davison","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1001\/archinternmed.2012.268","article-title":"Treatment intensity at the end of life in older adults receiving long-term dialysis.","volume":"172","author":"Wong","year":"2012","journal-title":"Arch Intern Med"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1001\/jamainternmed.2016.1200","article-title":"Quality of end-of-life care provided to patients with different serious illnesses.","volume":"176","author":"Wachterman","year":"2016","journal-title":"JAMA Intern Med"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"2380","DOI":"10.2215\/CJN.07170810","article-title":"Revised dialysis clinical practice guideline promotes more informed decision-making.","volume":"5","author":"Moss","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/S0272-6386(97)90279-1","article-title":"Factors influencing dialysis patients\u2019 completion of advance directives.","volume":"30","author":"Holley","year":"1997","journal-title":"Am J Kidney Dis"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/ndt\/gfp430","article-title":"Preferences for dialysis withdrawal and engagement in advance care planning within a diverse sample of dialysis patients.","volume":"25","author":"Kurella Tamura","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1001\/jama.1992.03480010067026","article-title":"How strictly do dialysis patients want their advance directives followed?","volume":"267","author":"Sehgal","year":"1992","journal-title":"JAMA"},{"key":"B11-20230813","article-title":"Use of advance directives in long-term care populations.","author":"Jones","year":"2011","journal-title":"NCHS Data Brief, no 54. Hyattsville, MD: National Center for Health Statistics."},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMoa0904655","article-title":"Functional status of elderly adults before and after initiation of dialysis.","volume":"361","author":"Kurella Tamura","year":"2009","journal-title":"N Engl J Med"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1093\/geront\/35.2.172","article-title":"Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS).","volume":"35","author":"Hawes","year":"1995","journal-title":"Gerontologist"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1093\/aje\/kwi188","article-title":"Easy SAS calculations for risk or prevalence ratios and differences.","volume":"162","author":"Spiegelman","year":"2005","journal-title":"Am J Epidemiol"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1177\/0269216315625856","article-title":"A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.","volume":"30","author":"Fung","year":"2016","journal-title":"Palliat Med"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"855","DOI":"10.2215\/CJN.11351015","article-title":"Provider perspectives on advance care planning for patients with kidney disease: Whose job is it anyway?","volume":"11","author":"O\u2019Hare","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.2215\/CJN.02180213","article-title":"Five policies to promote palliative care for patients with ESRD.","volume":"8","author":"Tamura","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1053\/j.ajkd.2015.11.024","article-title":"Nephrologist-facilitated advance care planning for hemodialysis patients: A quality improvement project.","volume":"68","author":"Amro","year":"2016","journal-title":"Am J Kidney Dis"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1053\/j.ajkd.2015.05.018","article-title":"Advance care planning and end-of-life decision making in dialysis: A randomized controlled trial targeting patients and their surrogates.","volume":"66","author":"Song","year":"2015","journal-title":"Am J Kidney Dis"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"888","DOI":"10.2215\/CJN.07410714","article-title":"How the ESRD quality incentive program could potentially improve quality of life for patients on dialysis.","volume":"10","author":"Moss","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1532-5415.1997.tb05178.x","article-title":"Advance directives for seriously ill hospitalized patients: Effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment.","volume":"45","author":"Teno","year":"1997","journal-title":"J Am Geriatr Soc"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.jpainsymman.2015.10.003","article-title":"POST forms more than advance directives associated with out-of-hospital death: Insights from a state registry.","volume":"51","author":"Pedraza","year":"2016","journal-title":"J Pain Symptom Manage"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"113","DOI":"10.7326\/0003-4819-141-2-200407200-00009","article-title":"Brief communication: The relationship between having a living will and dying in place.","volume":"141","author":"Degenholtz","year":"2004","journal-title":"Ann Intern Med"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1001\/jama.2011.1410","article-title":"Regional variation in the association between advance directives and end-of-life medicare expenditures.","volume":"306","author":"Nicholas","year":"2011","journal-title":"JAMA"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1056\/NEJMsa0907901","article-title":"Advance directives and outcomes of surrogate decision making before death.","volume":"362","author":"Silveira","year":"2010","journal-title":"N Engl J Med"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1111\/j.1532-5415.2011.03656.x","article-title":"The consistency between treatments provided to nursing facility residents and orders on the physician orders for life-sustaining treatment form.","volume":"59","author":"Hickman","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"c1345","DOI":"10.1136\/bmj.c1345","article-title":"The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial.","volume":"340","author":"Detering","year":"2010","journal-title":"BMJ"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1089\/jpm.2014.0031","article-title":"The power of advance care planning in promoting hospice and out-of-hospital death in a dialysis unit.","volume":"18","author":"Schmidt","year":"2015","journal-title":"J Palliat Med"},{"key":"B31-20230813","doi-asserted-by":"crossref","first-page":"256","DOI":"10.7326\/0003-4819-153-4-201008170-00008","article-title":"Redefining the \u201cplanning\u201d in advance care planning: Preparing for end-of-life decision making.","volume":"153","author":"Sudore","year":"2010","journal-title":"Ann Intern Med"},{"key":"B32-20230813","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jpainsymman.2013.03.010","article-title":"Impact of advance directives and a health care proxy on doctors\u2019 decisions: A randomized trial.","volume":"47","author":"Escher","year":"2014","journal-title":"J Pain Symptom Manage"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201703000-00011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:29Z","timestamp":1786368989000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201703000-00011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,5]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.07510716","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,5]]}}}