title: Timing of end-of-life care discussion with performance on end-of-life quality indicators in ovarian cancer.
abstract: OBJECTIVE
  (1) To describe the prevalence, timing and setting of documented end-of-life (EOL) discussions in patients with advanced ovarian cancer; and (2) to assess the impact of timing and setting of documented end-of-life discussions on EOL quality care measures.
  
  
  METHODS
  A retrospective study of women who died of ovarian cancer diagnosed between 1999 and 2008 was conducted. The following are the EOL quality measures assessed: chemotherapy in the last 14 days of life, >1 hospitalization in the last 30 days, >1 ER visit in the last 30 days, intensive care unit (ICU) admission in the last 30 days, dying in an acute care setting, admitted to hospice ≤3 days.
  
  
  RESULTS
  One hundred seventy-seven (80%) patients had documented end-of-life discussions. Median interval from EOL discussion until death was 29 days. Seventy-eight patients (44%) had EOL discussions as outpatient and 99 (56%) as inpatient. Sixty-four out of 220 (29%) patients' care did not conform to at least one EOL quality measure. An EOL discussion at least 30 days before death was associated with a lower incidence of: chemotherapy in the last 14 days of life (p=0.003), >1 hospitalization in the last 30 days (p<0.001), ICU admission in the last 30 days (p=0.005), dying in acute care setting (p=0.01), admitted to hospice ≤3 days (p=0.02). EOL discussion as outpatient was associated with fewer patients hospitalized >1 in the last 30days of life (p<0.001).
  
  
  CONCLUSIONS
  End-of-life care discussions are occurring too late in the disease process. Conformance with EOL quality measures can be achieved with earlier end-of-life care discussions.
authors.affiliation: Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA. micael.lopez@dm.duke.edu
authors.forename: Micael
authors.initials: M
authors.lastname: Lopez-Acevedo
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Arif H
authors.initials: AH
authors.lastname: Kamal
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
authors.forename: Angeles
authors.initials: A
authors.lastname: Alvarez Secord
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Fidel
authors.initials: F
authors.lastname: Valea
authors.forename: Paula S
authors.initials: PS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006295:Health Resources; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000592:standards*; D013997:Time Factors