• Martina Orlovic, Haider Warraich, Douglas Wolf, and Elias Mossialos.
• Imperial College London (M.O., E.M.), Department of Surgery and Cancer, London, UK. Electronic address: m.orlovic15@imperial.ac.uk.
• J Pain Symptom Manage. 2021 Dec 1; 62 (6): 119812061198-1206.

ContextAmericans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care.ObjectiveTo examine determinants of end-of-life planning; including, the effect of an individual's ageing and dying process, health status and socio-economic and racial/ethnic background.MethodsUS observational cohort study, using data from the Health and Retirement Study (1992 - 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics.ResultsEnd-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient's proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging.ConclusionsUnderstanding differences that increase end-of-life planning is important to incentivize patients' participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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