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Type: Journal article
Title: Costs and advance directives at the end of life: a case of the 'Coaching Older Adults and Carers to have their preferences Heard (COACH)' trial
Author: Kaambwa, B.
Ratcliffe, J.
Bradley, S.
Masters, S.
Davies, O.
Whitehead, C.
Milte, C.
Cameron, I.
Young, T.
Gordon, J.
Crotty, M.
Citation: BMC Health Services Research, 2015; 15(1):545-1-545-12
Publisher: BioMed Central
Issue Date: 2015
ISSN: 1472-6963
Statement of
Billingsley Kaambwa, Julie Ratcliffe, Sandra L. Bradley, Stacey Masters, Owen Davies, Craig Whitehead, Catherine Milte, Ian D. Cameron, Tracey Young, Jason Gordon and Maria Crotty
Abstract: Background: Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs). Methods: Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs. Results: The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs. Conclusion: For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.
Keywords: End of life; advance directives; care plans; costs
Rights: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI: 10.1186/s12913-015-1201-9
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