End-of-life care discussions among patients with advanced cancer: a cohort study.
BACKGROUND
National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year.


OBJECTIVE
To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these discussions take place.


METHODS
Prospective cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005.


METHODS
Participants lived in Northern California, Los Angeles County, North Carolina, Iowa, or Alabama or received care in 1 of 5 large HMOs or 1 of 15 Veterans Health Administration sites.


METHODS
2155 patients with stage IV lung or colorectal cancer.


METHODS
End-of-life care discussions reported in patient and surrogate interviews or documented in medical records through 15 months after diagnosis.


RESULTS
73% of patients had EOL care discussions identified by at least 1 source. Among the 1470 patients who died during follow-up, 87% had EOL care discussions, compared with 41% of the 685 patients who were alive at the end of follow-up. Of the 1081 first EOL care discussions documented in records, 55% occurred in the hospital. Oncologists documented EOL care discussions with only 27% of their patients. Among 959 patients with documented EOL care discussions who died during follow-up, discussions took place a median of 33 days before death.


CONCLUSIONS
The depth and quality of EOL care discussions was not evaluated. Much of the information about discussions came from surrogates of patients who died before baseline interviews could be obtained.


CONCLUSIONS
Although most patients with stage IV lung or colorectal cancer discuss EOL care planning with physicians before death, many discussions occur during acute hospital care, with providers other than oncologists, and late in the course of illness.


BACKGROUND
National Cancer Institute and Department of Veterans Affairs.
Dana-Farber Cancer Institute, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Jennifer W
JW
Mack
Angel
A
Cronin
Nathan
N
Taback
Haiden A
HA
Huskamp
Nancy L
NL
Keating
Jennifer L
JL
Malin
Craig C
CC
Earle
Jane C
JC
Weeks
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000628:therapy*; D003142:Communication; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010166:Palliative Care; D010347:Patient Care Planning / Q000592:standards / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D013727:Terminal Care / Q000592:standards / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult