title: Acceptance of Advance Directives and Palliative Care Referral for Veterans With Advanced Cancer: A Retrospective Analysis.
abstract: OBJECTIVE
  To evaluate the documentation of advance directive (ADs) and physician orders for life-sustaining treatment (POLST) with acceptance of palliative care (PC) services referral among patients with cancer.
  
  
  METHODS
  We retrospectively reviewed veterans with advanced cancers at the Veterans Administration Palo Alto Health Care System. Chi-square tests estimated AD and POLST documentation and referral to PC. Logistic regression models estimated the odds of AD and POLST documentation and PC referral.
  
  
  RESULTS
  Two hundred and forty-six veterans were diagnosed with cancer. In all, 53% had a documented AD, 5% had a POLST, and 47% accepted referral to PC. The AD documentation was not associated with acceptance of PC.
  
  
  CONCLUSIONS
  We found no association of AD documentation and PC referral. Future studies should evaluate other factors that influence referral to these services.
authors.affiliation: Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA manalip@stanford.edu.
authors.forename: Manali I
authors.initials: MI
authors.lastname: Patel
authors.affiliation: Health Policy & Research, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Kahn
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000706:statistics & numerical data*; D044469:Racial Groups; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014728:Veterans / Q000706:statistics & numerical data*
keywords: advance directives; advanced cancer; end of life; hospice; palliative care; veterans administration