In Reply: I generally agree with Dr Lynn's comments, which do not diverge from our article. However, I offer the following caveats.
First, Lynn contends that increased use of advanced care planing may reduce demand for ICU care, especially in the very old. We modeled this scenario explicitly (Table 2 of our article), where we anticipated a 20% decrease in demand by those aged 85 years and older and a 10% decrease by those aged 75 to 84 years. We considered this decrease to be large, given that many patients may not desire any decrease in aggressiveness of care. However, there was little effect on our projections. There is also a growing literature suggesting advance care planning has little impact on the costs of care or use of health care technologies.1,2
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