Kara and colleagues report that advance care planning (ACP) is associated with lower rates of in-hospital death, higher rates of hospice enrollment, and lower rates of hospice stays lasting less than 3 days among those who enrolled.Let's say that people could be divided generally into those who are more reconciled to the idea of dying and more accepting of a palliative course when death is near and those who are less reconciled and accepting. The former group might be more likely to participate in ACP and at the same time more likely to move to hospice and stay there than those who cannot accept a palliative course. This association might undercut the authors' assertion that "each aspect of ACP affects end-of-life care"; both measures may be expressions of a single underlying difference in the population. This difference may also partially, and only partially, explain the high rates of satisfaction in hospice and palliative care.
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