Early and late code status documentation in cancer patients managed by a dedicated supportive care team

Given the end-of-life (EOL) focus of supportive care teams, clinicians in these settings may play a proactive role in facilitating early code status (CS) documentation (> 30 days before death) by fostering patients' and families' understanding, preparedness, and acceptance. This retrospective study was conducted to compare the incidence, types, and predictors of early and late CS documentation among patients managed by a dedicated supportive-care team.

CS documentation data were extracted from the medical records of 134 deceased patients at a comprehensive cancer center. The incidence, types, and predictors (sociodemographic, medical, supportive care, and end-of-life-related characteristics) of early (> 30 days before death) and late (≤ 30 days before death) CS documentation were compared.

At the time of death, 85% of patients had documented CSs (early, 36%). The median (mean ± standard deviation) times of early and late CS documentation were 112 (174 ± 165) and 12 (12 ± 8) days before death, respectively. In early documentation, the do-not-resuscitate (DNR) CS was more common than the best-supportive-care (BSC) CS (54% vs. 46%); the reverse characterized late CS documentation (BSC 71% vs. DNR 29%). Predictors of early versus late CS documentation were being married/partnered [OR 3.05; 95% CI, 1.07-8.72; p = 0.038], gynecological/breast cancer diagnosis (OR 4.44; 95% CI, 1.22-16.12; p = 0.023), lung cancer diagnosis (OR 7.75; 95% CI, 1.99-30.15; p = 0.003), and performance status indicating minimal functional restriction at initiation of supportive care (OR 4.26; 95% CI, 1.13-16.14; p = 0.033).

In the study context, CS documentation was frequent but often late. Although a dedicated supportive care team may allow a high overall frequency of CS documentation, additional clinical approaches are needed to promote earlier CS documentation.