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Differential Impact of a Multicomponent Goals-of-Care Program in Patients with Hematologic and Solid Malignancies

David Hui1, Sairah Ahmed2,3, Nico Nortje4

  • 1Department of Palliative, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA.

Cancers
|March 11, 2023
PubMed

Insights

The myGOC program improved goals-of-care documentation for both hematologic and solid tumor patients. However, intensive care unit mortality only decreased for solid tumor patients, not those with hematologic malignancies.

Area of Science:

  • Oncology
  • Critical Care Medicine
  • Health Services Research

Background:

  • An interdisciplinary multicomponent goals-of-care (myGOC) program previously showed improved documentation and hospital outcomes.
  • The differential impact of the myGOC program on patients with hematologic malignancies versus solid tumors remained unclear.

Purpose of the Study:

  • To compare the changes in hospital outcomes and goals-of-care (GOC) documentation before and after myGOC program implementation.
  • To assess if the benefits of the myGOC program were uniform across patients with hematologic malignancies and solid tumors.

Main Methods:

  • Retrospective cohort study comparing medical inpatients before (May-Dec 2019) and after (May-Dec 2020) myGOC implementation.
  • Primary outcome: intensive care unit (ICU) mortality. Secondary outcome: GOC documentation.
  • Included 5036 patients with hematologic malignancies and 6563 with solid tumors.

Main Results:

  • ICU mortality showed no significant change for hematologic malignancy patients (26.4% vs. 28.3%).
  • ICU mortality significantly reduced for solid tumor patients (32.6% vs. 18.8%), with a significant between-group difference (OR 2.29).
  • GOC documentation improved significantly in both groups, with greater improvement in the hematologic group.

Conclusions:

  • Despite enhanced GOC documentation in the hematologic malignancy group, ICU mortality did not improve.
  • The myGOC program led to a significant reduction in ICU mortality specifically for patients with solid tumors.
  • The effectiveness of the myGOC program in improving critical care outcomes varies between hematologic and solid tumor patient populations.

Keywords:
advance care planningcommunicationhematologic neoplasmsintensive care unitspalliative carequality of health care

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