title: Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death.
abstract: BACKGROUND
  Patient gender plays a significant role in patient-physician communication, patients' understanding of illness, and the aggressiveness of end-of-life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The current study was aimed at determining whether gender differences exist in the receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and the receipt of EoL ICU care.
  
  
  METHODS
  This was a multisite, prospective cohort study of patients (n = 353) with metastatic cancers who were identified as terminally ill at study enrollment and were interviewed at a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life.
  
  
  RESULTS
  Patients who received ICU care at the EoL were more likely to be male than those who did not (73% vs 52%, P = .02). After adjustments for potential confounders, male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than male patients with no EoL discussion (adjusted odds ratio, 0.26, 95% confidence interval, 0.07-0.91; P = .04). There was no association between EoL discussions and ICU stays near death among female patients.
  
  
  CONCLUSIONS
  Men with advanced cancers are more likely than women to receive aggressive, nonbeneficial ICU care near death. Gender differences in the effects of EoL discussions on EoL care likely contribute to and may even explain gender differences in the receipt of ICU care in the last week of life.
authors.affiliation: Division of Hospital Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rashmi K
authors.initials: RK
authors.lastname: Sharma
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Penedo
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012727:Sex Characteristics; D013727:Terminal Care
keywords: advanced cancer; communication; end-of-life care; end-of-life discussions; gender differences