title: A Patient-Reported Outcome Instrument to Facilitate Timing of End-of-Life Discussions among Patients with Advanced Cancers.
abstract: BACKGROUND
  Honoring the wishes of cancer patients is a responsibility of oncologists; however, end-of-life care (EOLC) discussions are frequently delayed past the point of usefulness.
  
  
  OBJECTIVE
  To develop a patient-reported outcome (PRO) screening tool that facilitates timing of EOLC discussions.
  
  
  METHODS
  A seven-item PRO instrument covering four clinical and personhood domains [performance status, pain, burden (financial and family), and depression] was administered to patients with advanced malignancies undergoing noncurative therapy. The PRO instrument included the patient's assessment of the importance of each domain. Results were correlated with the oncologist's assessment of appropriateness of continuing aggressive therapy.
  
  
  METHODS
  Four hundred thirty-three patients fully completed the PRO instrument between February and March 2015 at a single outpatient cancer center.
  
  
  RESULTS
  There was a difference (p < 0.0001) in median scores among cohorts deemed by their oncologists appropriate to continue noncurative treatments versus patients whose physicians were contemplating or actively engaged in EOLC discussions. The scores for the four individual domains also differed among cohorts. An upper threshold score comprising 46% of patients deemed appropriate to curtail treatment (but inclusive of only 26% of patients deemed appropriate to continue) was determined, facilitating identification of patients for EOLC discussions.
  
  
  CONCLUSIONS
  A seven-item patient-centric PRO instrument was able to separate advanced malignancy patients into cohorts who their physicians deemed were at differing stages in their cancer journey with increasing needs for advance care planning. A study to determine if the threshold scores identified in this pilot correlate with palliative/EOL consultation frequency and patient survival is underway.
authors.affiliation: 1 Cancer Outcomes Tracking and Analysis (COTA, Inc.), New York, New York.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldberg
authors.affiliation: 2 Regional Cancer Care Associates-Hackensack Division , Hackensack, New Jersey.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pecora
authors.affiliation: 3 Department of Pain and Palliative Care, John Theurer Cancer Center at Hackensack University Medical Center , Hackensack, New Jersey.
authors.forename: Jose
authors.initials: J
authors.lastname: Contreras
authors.affiliation: 3 Department of Pain and Palliative Care, John Theurer Cancer Center at Hackensack University Medical Center , Hackensack, New Jersey.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: DeMarco
authors.affiliation: 1 Cancer Outcomes Tracking and Analysis (COTA, Inc.), New York, New York.
authors.forename: Dhakshila
authors.initials: D
authors.lastname: Paramanathan
authors.affiliation: 1 Cancer Outcomes Tracking and Analysis (COTA, Inc.), New York, New York.
authors.forename: Victoria
authors.initials: V
authors.lastname: DeVincenzo
authors.affiliation: 1 Cancer Outcomes Tracking and Analysis (COTA, Inc.), New York, New York.
authors.forename: Eric
authors.initials: E
authors.lastname: Schultz
authors.affiliation: 1 Cancer Outcomes Tracking and Analysis (COTA, Inc.), New York, New York.
authors.forename: Kelly
authors.initials: K
authors.lastname: Choi