title: Code status documentation in the outpatient electronic medical records of patients with metastatic cancer.
abstract: BACKGROUND
  Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medical records.
  
  
  OBJECTIVE
  To assess the rate of documentation of code status in the electronic longitudinal medical records (LMR) of patients with metastatic cancer.
  
  
  METHODS
  Retrospective review of 2,498 patients with metastatic solid tumors at an academic cancer center. An electronic patient database and the LMR were queried to identify demographic information, cancer type, number of clinic visits, and documentation of code status.
  
  
  METHODS
  The sample consisted of adult patients with metastatic prostate, breast, ovarian, bladder kidney, colorectal, non-colorectal gastrointestinal (GI), and lung cancers.
  
  
  METHODS
  Primary outcome was the percentage of documented code status in the LMR.
  
  
  RESULTS
  Among the 2,498 patients, 20.3% had a documented code status. Code status was designated most frequently in patients with non-colorectal GI (193/609, 31.7%) and lung (179/583, 30.7%) cancers and least frequently in patients with genitourinary malignancies [bladder/kidney (4/89, 4.5%), ovarian (4/93, 4.3%), and prostate (7/365, 1.9%) cancers]. Independent predictors of having documented code status included religious affiliation, cancer type, and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI.
  
  
  CONCLUSIONS
  Despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medical record.
authors.affiliation: Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA 02114, USA. jtemel@partners.org
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.forename: Sonal
authors.initials: S
authors.lastname: Admane
authors.forename: Jessica
authors.initials: J
authors.lastname: Solis
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Cashavelly
authors.forename: Stephen
authors.initials: S
authors.lastname: Doherty
authors.forename: Rebecca
authors.initials: R
authors.lastname: Heist
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000592:standards*; D004282:Documentation / Q000379:methods / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000628:therapy; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D016414:Resuscitation Orders; D012189:Retrospective Studies