Timing of code status documentation and end-of-life outcomes in patients admitted to an oncology ward.
OBJECTIVE
Guidelines recommend documentation of care preferences for patients with advanced cancer upon hospital admission.We assessed end-of-life outcomes for patients who did or did not have code status (CS) documented within 48 h of admission.


METHODS
This was a retrospective cohort study of patients who died on an inpatient oncology ward between January 2004 and February 2009. Primary end-of-life outcomes were "code blues" and cardiopulmonary resuscitation (CPR) attempts; secondary outcomes included unsuccessful CPR attempts, intensive care unit (ICU), consultations, and ICU admissions. Using logistic regression, outcomes were compared between those with and without CS documentation ≤ 48 h from admission (full code or do-not-resuscitate), controlling for significant confounders.


RESULTS
The 336 patients had a median age of 61 years; 97 % had advanced cancer. The median time from admission to death was 12 days (range <1-197 days); 151 patients (45 %) had CS documentation ≤ 48 h from admission. Controlling for confounders of reason for admission and marital status, patients with CS documentation ≤ 48 h from admission had fewer "code blues" (2 vs. 15 %; adjusted odds ratio(AOR) 0.12, 95% confidence interval (CI) 0.02-0.43), CPR attempts (1 vs. 11 %; AOR 0.12, 95 % CI 0.01-0.51), unsuccessful CPR attempts (0 vs. 11 %), ICU consultations (9 vs. 30 %; AOR 0.19, 95 % CI 0.08-0.40) and ICU admissions (2 vs. 5 %; AOR 0.18, 95 %CI 0.02-0.85).


CONCLUSIONS
In patients who died on an oncology ward, CS documentation within 48 h of admission was associated with less aggressive end-of-life care, regardless of the reason for admission.
Amanda
A
Caissie
Nanor
N
Kevork
Breffni
B
Hannon
Lisa W
LW
Le
Camilla
C
Zimmermann
D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D015331:Cohort Studies; D004282:Documentation / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult