title: Advance directives and do-not-resuscitate orders in patients with cancer with metastatic spinal cord compression: advanced care planning implications.
abstract: OBJECTIVE
  Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC.
  
  
  METHODS
  We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations.
  
  
  RESULTS
  The mean age of this patient population was 55 years (range, 24-81). Thirty patients (33%) were female. Twenty patients (23%) had a living will, 27 patients (31%) had health care proxies, and 10 patients (11%) had either out-of-hospital DNR order and/or dictated DNR note. The median survival time for these patients was 4.3 months.
  
  
  CONCLUSIONS
  Despite strong evidence showing short survival times for MSCC patients, it seems many of these patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-of-life palliative care and suboptimal doctor-patient communication. Using the catastrophic event of a diagnosis of MSCC to trigger communication and initiate palliative care may be beneficial to patients and their families.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. yguo@mdanderson.org
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Josephine
authors.initials: J
authors.lastname: Bianty
authors.forename: Benedict
authors.initials: B
authors.lastname: Konzen
authors.forename: Ki
authors.initials: K
authors.lastname: Shin
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000331:legislation & jurisprudence*; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006285:Health Planning / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D010166:Palliative Care / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology*; D013125:Spinal Neoplasms / Q000150:complications* / Q000556:secondary*; D014481:United States; D055815:Young Adult