title: Doctors' reports about palliative systemic treatment: A medical record study.
abstract: Decisions about palliative systemic treatment are key elements of palliative and end-of-life care. Such decisions must often be made in complex, clinical situations.
  
  
  
  To explore the content of medical records of patients with advanced non-small cell lung cancer and pancreatic cancer with specific emphasis on doctors' notes about decisions on palliative systemic treatment.
  
  
  
  Medical record review (2009-2012) of 147 cancer patients containing 276 notes about palliative systemic treatment. We described the proportion of notes/medical records containing pre-specified items relevant to palliative systemic treatment. We selected patients using the nationwide Netherlands Cancer Registry.
  
  
  
  Hospital based.
  
  
  
  About 75% of all notes reported doctors' considerations to start/continue palliative systemic treatment, including information about the prognosis (47%), possible survival gain (22%), patients' wish for palliative systemic treatment (33%), impact on quality of life (8%), and patient's age (3%). Comorbidity (82%), smoking status (78%) and drinking behaviour (63%) were more often documented than patients' performance status (16%). Conversations with the patient/family about palliative systemic treatment were reported in 49% of all notes. Response measurements and dose adaptations were documented in 75% and 71% of patients who received palliative systemic treatment respectively.
  
  
  
  Medical records provide insight into the decision-making process about palliative systemic treatment. The content and detail of doctors' notes, however, widely varies especially concerning their palliative systemic treatment considerations. Registries that aim to measure the quality of (end-of-life) care must be aware of this outcome. Future research should further explore how medical records can best assist in evaluating the quality of the decision-making process in the patient's final stage of life.
authors: 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.|2 Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors: Hilde M
authors: HM
authors: Buiting
authors: 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
authors: Mirian
authors: M
authors: Brink
authors: 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.|3 Department of Clinical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Marleen N
authors: MN
authors: Wijnhoven
authors: 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
authors: Martine E
authors: ME
authors: Lokker
authors: 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
authors: Lydia Gm
authors: LG
authors: van der Geest
authors: 4 Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands.
authors: Wim E
authors: WE
authors: Terpstra
authors: 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.|5 Department of Medical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Gabe S
authors: GS
authors: Sonke
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002289:Carcinoma, Non-Small-Cell Lung / Q000523:psychology* / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care / Q000523:psychology*; D010190:Pancreatic Neoplasms / Q000523:psychology* / Q000628:therapy*; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*
keywords: Medical records; decision-making; drug therapy; palliative care; patient-centred