End-of-life care discussions among patients with advanced cancer: a cohort study
- 1Dana-Farber Cancer Institute, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
- 0Dana-Farber Cancer Institute, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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View abstract on PubMed
Summary
This summary is machine-generated.Most patients with stage IV cancer have end-of-life (EOL) care discussions, but many occur late and in hospitals. Further research is needed to improve the quality and timing of these crucial conversations.
Area Of Science
- Oncology
- Palliative Care
- Health Services Research
Background
- National guidelines advocate for end-of-life (EOL) care planning discussions for cancer patients with a prognosis of less than one year.
- Physician-patient communication regarding EOL care is crucial for aligning treatment with patient values.
Purpose Of The Study
- To determine the incidence of EOL care discussions among patients with stage IV lung or colorectal cancer.
- To identify the setting, timing, and healthcare providers involved in these EOL care discussions.
Main Methods
- Prospective cohort study involving 2155 patients diagnosed with stage IV lung or colorectal cancer between 2003 and 2005.
- Data collected through patient/surrogate interviews and medical record review up to 15 months post-diagnosis.
- Participants were recruited from diverse healthcare settings across multiple US states.
Main Results
- 73% of patients had documented EOL care discussions; this was higher (87%) for those who died during follow-up compared to survivors (41%).
- Over half (55%) of initial EOL discussions occurred in a hospital setting.
- Oncologists documented discussions with only 27% of patients, and for those who died, discussions occurred a median of 33 days before death.
Conclusions
- While most stage IV lung and colorectal cancer patients engage in EOL care planning, discussions often happen late and in acute care settings.
- A significant proportion of these discussions involve non-oncologist providers.
- The study did not assess the depth or quality of EOL discussions, and relied partly on surrogate reports.
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