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Research Letter
Less Is More
May 18, 2017

Persistent Gaps in Use of Advance Directives Among Nursing Home Residents Receiving Maintenance Dialysis

Author Affiliations
  • 1Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, California
  • 2Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
  • 3Kidney Research Institute, Department of Medicine, University of Washington, Seattle
  • 4Hospital and Specialty Medicine, Veteran Affairs Puget Sound Health Care System, Seattle, Washington
  • 5Division of Palliative Care, Palo Alto VA Health Care System, Stanford University School of Medicine, Palo Alto, California
JAMA Intern Med. Published online May 18, 2017. doi:10.1001/jamainternmed.2017.1618

Patients with end-stage renal disease receiving dialysis have a symptom burden and prognosis comparable to patients with incurable cancer.1,2 They frequently and increasingly receive intensive procedures near the end of life.2 Because the benefits of these interventions remain controversial,3 a key question is whether increasing intensity of end-of-life care reflects changes in the extent to which patient preferences are elicited and documented with advance directives. Nursing homes offer an important setting to evaluate advance directive use because they accept full responsibility for care during patient stay.

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