Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Goals of Care (GOC) discussions are crucial for advanced cancer patients.
• These conversations can be affected by patient and oncologist factors during care transitions.

Purpose of the Study:

• To assess oncologists' awareness, anticipation, and recollection of GOC discussions for deceased patients.
• To identify factors influencing GOC discussions and documentations.
• To examine barriers to GOC conversations and advance directives (ADs).

Main Methods:

• Surveys administered to medical oncologists regarding deceased inpatients.
• Retrospective review of electronic health records for GOC documentation and ADs.
• Analysis of associations between patient, oncologist, and relationship factors and outcomes.

Main Results:

• 66% of surveys completed; 77.9% of oncologists aware of patient deaths, 64.4% recalled GOC discussions.
• Outpatient oncologists had higher awareness of death; inpatient oncologists better anticipated death.
• Only 21.3% had documented GOC discussions pre-admission; 33.3% had ADs.
• Barriers included unrealistic patient/family expectations and decreased patient participation.

Conclusions:

• While oncologists recall GOC discussions, documentation remains insufficient.
• Barriers to effective GOC conversations and documentation require further investigation.
• Understanding challenges during care transitions is essential for improving end-of-life care.