title: Association of goals of care meetings for hospitalized cancer patients at risk for critical care with patient outcomes.
abstract: BACKGROUND
  Caring for cancer patients with advanced and refractory disease requires communication about care preferences, particularly when patients become ill enough to be at risk for critical care interventions potentially inconsistent with their preferences.
  
  
  OBJECTIVE
  To describe the use of goals of care discussions in patients with advanced/refractory cancer at risk for critical care interventions and evaluate associations between these discussions and outcomes.
  
  
  METHODS
  Cohort study describing patients/families' perceptions of goals of care meetings and comparing health care utilization outcomes of patients who did and did not have discussions.
  
  
  METHODS
  Inpatient units of an academic cancer center. Included patients had metastatic solid tumors or relapsed/refractory lymphoma or leukemia and were at risk for critical care, defined as requiring supplemental oxygen and/or cardiac monitor.
  
  
  RESULTS
  Of 86 patients enrolled, 34 (39%) had a reported goals of care discussion (study group). Patients/families reported their needs and goals were addressed moderately to quite a bit during the meetings. Patients in the study group were less likely to receive critical care (0% vs 22%, p = 0.003) and more likely to be discharged to hospice (48% vs 30%, p = 0.04) than the control group. Only one patient in the study group died during the index hospitalization (on comfort care) (3%) compared with 9(17%) in the control group (p = 0.08).
  
  
  CONCLUSIONS
  Goals of care meetings for advanced/refractory cancer inpatients at risk for critical care interventions can address patient and family goals and needs and improve health care utilization. These meetings should be part of routine care for these patients.
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA apostco@jhmi.edu.
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Apostol
authors.affiliation: Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Waldfogel
authors.affiliation: Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.affiliation: Department of Social Work, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: List
authors.affiliation: Harry J. Duffey Family Pain and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA.
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Billing
authors.affiliation: Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Suzanne A
authors.initials: SA
authors.lastname: Nesbit
authors.affiliation: Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Harry J. Duffey Family Pain and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA.
authors.forename: Sydney Morss
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006040:Goals; D006301:Health Services Needs and Demand; D017051:Hospice Care / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010347:Patient Care Planning; D057240:Patient Preference; D010865:Pilot Projects
keywords: Palliative medicine; communication; critical care; goals of care; hospice; hospital care; intensive care; palliative care; readmissions