Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment
Open accessAbstract
CONTEXT: Talking about death can be difficult. Without evidence that end-of-life discussions improve patient outcomes, physicians must balance their desire to honor patient autonomy against a concern of inflicting psychological harm. OBJECTIVE: To determine whether end-of-life discussions with physicians are associated with fewer aggressive interventions. DESIGN, SETTING, AND PARTICIPANTS: A US multisite, prospective, longitudinal cohort study of patients with advanced cancer and their informal caregivers (n = 332 dyads), September 2002-February 2008. Patients were followed up from enrollment to death, a median of 4.4 months later. Bereaved caregivers' psychiatric illness and quality of life was assessed a median of 6.5 months later. MAIN OUTCOME MEASURES: Aggressive medical care (eg, ventilation, resuscitation) and hospice in the final week of life. Secondary outcomes included patients' mental health and caregivers' bereavement adjustment. RESULTS: One hundred twenty-three of 332 (37.0%) patients reported having end-of-life discussions before baseline. Such discussions were not associated with higher rates of major depressive disorder (8.3% vs 5.8%; adjusted odds ratio [OR], 1.33; 95% confidence interval [CI], 0.54-3.32), or more worry (mean McGill score, 6.5 vs 7.0; P = .19). After propensity-score weighted adjustment, end-of-life discussions were associated with lower rates of ventilation (1.6% vs 11.0%; adjusted OR, 0.26; 95% CI, 0.08-0.83), resuscitation (0.8% vs 6.7%; adjusted OR, 0.16; 95% CI, 0.03-0.80), ICU admission (4.1% vs 12.4%; adjusted OR, 0.35; 95% CI, 0.14-0.90), and earlier hospice enrollment (65.6% vs 44.5%; adjusted OR, 1.65;95% CI, 1.04-2.63). In adjusted analyses, more aggressive medical care was associated with worse patient quality of life (6.4 vs 4.6; F = 3.61, P = .01) and higher risk of major depressive disorder in bereaved caregivers (adjusted OR, 3.37; 95% CI, 1.12-10.13), whereas longer hospice stays were associated with better patient quality of life (mean score, 5.6 vs 6.9; F = 3.70, P = .01). Better patient quality of life was associated with better caregiver quality of life at follow-up (beta = .20; P = .001). CONCLUSIONS: End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment.
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Claims the paper makes
0 of 18 cited sources checked · 0 supported · 0 flagged
- Findingown data
Caregivers of patients with high quality of life felt better prepared for the death.
“Caregivers of patients with high QoL felt better prepared for the death (β=0.23, p=0.002)”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
Patients who reported end-of-life discussions had lower performance status than those who did not.
“Patients reporting discussions had lower performance status (59.5 vs. 65.7; p=0.003)”
Quote in the paperNot a substantial claim - Findingown data
Longer hospice stays were linked to better patient quality of life near death.
“while longer hospice stays were associated with better patient QoL (5.6 vs. 6.9; F=3.70, p=0.01)”
- Also stated in: § Patients’ Quality of Life at EOL · plain
“The inverse was true for hospice care, where patients’ QoL improved the longer they were enrolled, except for patients who received less than one week of services.”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Also stated in: § Patients’ Quality of Life at EOL · plain
- Findingown data
Caregivers of patients who received any aggressive care were more likely to feel unprepared for the patient's death.
“Caregivers of patients who received any aggressive care were at higher risk for developing a Major Depressive Disorder (AOR 3.37, 95% CI 1.12-10.13), experiencing regret (β=0.17; p=0.01), and feeling unprepared for the patient’s death (β=−0.30; p<0.001)”
Quote in the paperSubstantial claim - Findingown data
High patient quality of life was linked to improvements in caregivers' self-rated change in health.
“improvements in self-rated change in health (AOR 1.17, 95% CI 1.05, 1.29)”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
At baseline, 123 of 332 patients (37.0%) said they had discussed end-of-life matters with a doctor.
“123 of 332 (37.0%) patients reported EOL discussions before baseline.”
- Also stated in: § Patient characteristics · plain
“Overall, 123 of 332 (37.0%) patients reported having EOL discussions with their physicians at baseline.”
Quote in the paperNot a substantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Patient characteristics · plain
- Findingown data
Patients who reported end-of-life conversations were more likely to complete a do-not-resuscitate order.
“complete a do-not-resuscitate order (63.0% vs. 28.5%).”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Findingown data
Patients who reported end-of-life conversations were more likely to accept that their illness was terminal.
“Patients who reported EOL conversations were significantly (p≥0.001) more likely to accept that their illness was terminal (52.9% vs. 28.7%)”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Findingown data
Receiving more aggressive medical care was linked to a higher risk of Major Depressive Disorder among bereaved caregivers.
“higher risk for Major Depressive Disorder in bereaved caregivers (AOR 3.37, 95% CI 1.12-10.13)”
- Also stated in: § Bereavement Outcomes · plain
“Caregivers of patients who received any aggressive care were at higher risk for developing a Major Depressive Disorder (AOR 3.37, 95% CI 1.12-10.13)”
Quote in the paperSubstantial claim - Also stated in: § Bereavement Outcomes · plain
- Findingown data
In propensity-weighted analyses, patients reporting end-of-life discussions did not show higher levels of depression, sadness, terror, worry, or DSM-IV mental disorder diagnoses.
“As shown in table 2, EOL discussions were not associated with patients feeling “depressed,” “sad,” “terrified,” “worried,” or meeting DSM-IV-criteria for a mental disorder in propensity-weighted analyses.”
- Also stated in: § DISCUSSION · plain
“we found no evidence that they were significantly associated with increased emotional distress or psychiatric disorders.”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § DISCUSSION · plain
- Findingown data
High patient quality of life was linked to better caregiver mental health.
“mental health (β=0.13, p=0.04)”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
High patient quality of life was linked to better caregiver self-reported health.
“self-reported health (β=0.17, p=0.004)”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
After propensity-score weighting, patients who reported end-of-life discussions had lower rates of intensive care unit admission.
“ICU admission (4.1 vs. 12.4%; AOR 0.35, 95% CI 0.14-0.90)”
- Also stated in: § Medical care at the end-of-life · plain
“be admitted to the intensive care unit (4.1% vs. 12.4%; p=0.03)”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Medical care at the end-of-life · plain
- Findingown data
Patients who reported end-of-life discussions had shorter survival times than those who did not.
“shorter survival times (95 vs. 154 days; p=0.002)”
Quote in the paperNot a substantial claim - Findingown data
High patient quality of life was linked to better caregiver physical functioning.
“physical functioning (β=0.14, p=0.02)”
Quote in the paperNot a substantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
Less aggressive care and earlier hospice referrals were linked to better patient quality of life near death.
“Less aggressive care and earlier hospice referrals were associated with better patient QoL near death.”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
Major Depressive Disorder was not more common among patients who reported end-of-life discussions.
“EOL discussions were not associated with higher rates of Major Depressive Disorder (8.3% vs. 5.8; AOR 1.33, 95% CI 0.54-3.32)”
- Also stated in: § Mental health, treatment preferences, and advance care planning · plain
“EOL discussions were not associated with patients feeling “depressed,” “sad,” “terrified,” “worried,” or meeting DSM-IV-criteria for a mental disorder in propensity-weighted analyses.”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Mental health, treatment preferences, and advance care planning · plain
- Findingown data
High patient quality of life was linked to better caregiver overall quality of life.
“High patient QoL was associated with better caregiver outcomes, including overall QoL (β=0.20; p=0.001)”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
Better patient quality of life was linked to better caregiver quality of life at follow-up.
“Better patient QoL was associated with better caregiver QoL at follow-up (β=0.20; p=0.001).”
- Also stated in: § Bereavement Outcomes · plain
“High patient QoL was associated with better caregiver outcomes, including overall QoL (β=0.20; p=0.001)”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Also stated in: § Bereavement Outcomes · plain
- Findingown data
Patients who reported end-of-life conversations were more likely to prefer comfort-focused treatment over life-extending therapy.
“prefer medical treatment focused on relieving pain and discomfort over life-extending therapies (85.4% vs. 70.0%)”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Findingown data
Rates of reported end-of-life conversations varied significantly by site, from 61.5% at New Hampshire Hematology Oncology to 16.2% at Yale Cancer Center.
“There were, however, significant site differences with 61.5% of patients at New Hampshire Hematology Oncology reporting EOL conversations compared to 16.2% at Yale Cancer Center (p<0.001).”
Quote in the paperNot a substantial claim - Findingown data
Caregivers of patients with high quality of life experienced less regret.
“and experienced less regret (β=−0.30, p<0.001) at follow-up.”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
In adjusted analyses, receiving more aggressive medical care was linked to worse patient quality of life near death.
“In adjusted analyses, more aggressive medical care was associated with worse patient QoL (6.4 vs. 4.6; F=3.60, p=0.01)”
- Also stated in: § Patients’ Quality of Life at EOL · plain
“Patients who received no aggressive care had a mean QoL score of 6.4, while patients who received 3 or more therapies had a mean QoL score of 4.6 (F=3.61, df=3, p=0.01).”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Also stated in: § Patients’ Quality of Life at EOL · plain
- Findingown data
Caregivers of patients who received any aggressive care were more likely to experience regret.
“Caregivers of patients who received any aggressive care were at higher risk for developing a Major Depressive Disorder (AOR 3.37, 95% CI 1.12-10.13), experiencing regret (β=0.17; p=0.01), and feeling unprepared for the patient’s death (β=−0.30; p<0.001)”
Quote in the paperSubstantial claim - Findingown data
Patients who reported end-of-life discussions had higher symptom burden than those who did not.
“higher symptom burden (5.0 vs. 5.6; p=0.02)”
Quote in the paperNot a substantial claim - Findingown data
After propensity-score weighting, patients who reported end-of-life discussions had lower rates of resuscitation.
“resuscitation (0.8% vs. 6.7%; AOR 0.16, 95% CI 0.03-0.80)”
- Also stated in: § Medical care at the end-of-life · plain
“undergo resuscitation (0.8% vs. 6.7%; p=0.03)”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Medical care at the end-of-life · plain
- Findingown data
Worry scores did not differ significantly between patients with and without end-of-life discussions.
“or more “worry” (6.5 vs. 7.0; p=0.19))”
- Also stated in: § Mental health, treatment preferences, and advance care planning · plain
“EOL discussions were not associated with patients feeling “depressed,” “sad,” “terrified,” “worried,” or meeting DSM-IV-criteria for a mental disorder in propensity-weighted analyses.”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Mental health, treatment preferences, and advance care planning · plain
- Findingown data
Patients who received less than one week of hospice care had quality-of-life scores similar to those who received no hospice at all.
“patients who received less than one week of hospice care had the same QoL scores as patients who did not receive hospice at all”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Findingown data
After propensity-score weighting, patients who reported end-of-life discussions had lower rates of mechanical ventilation.
“After propensity-score weighted adjustment, EOL discussions were associated with lower rates of ventilation (1.6% vs. 11.0%; AOR 0.26, 95% CI 0.08-0.83)”
- Also stated in: § Medical care at the end-of-life · plain
“patients who reported EOL discussions were less likely to receive mechanical ventilation (1.6% vs. 11.0%; p=0.02)”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Medical care at the end-of-life · plain
- Findingown data
After propensity-score weighting, patients who reported end-of-life discussions were more likely to enroll in hospice earlier (more than one week before death).
“earlier hospice enrollment (65.6% vs. 44.5%; AOR 1.58, 95% CI 1.04-2.63)”
- Also stated in: § Medical care at the end-of-life · plain
“Patients reporting EOL discussions were more likely to be enrolled in outpatient hospice for more than one week (65.6% vs. 44.5%, p=0.03).”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Also stated in: § Medical care at the end-of-life · plain
- Findingown data
Caregivers of patients who received any aggressive care had worse overall quality of life.
“They also had worse QoL outcomes, including overall QoL (β=−0.15; p=0.004), self-reported health (β=−0.12; p=0.04), and increased role limitations (β=0.17; p=0.008).”
Quote in the paperSubstantial claim - Findingown data
Patients' recall of end-of-life discussions varied significantly by site, with fewer reports at a major academic center.
“Interestingly, patients’ recall of EOL discussion varied significantly by site, with fewer patients reporting EOL discussions at a major academic center.”
Quote in the paperNot a substantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Findingown data
Patients with lower Karnofsky scores, higher symptom burdens, and shorter median survivals were more likely to report having end-of-life conversations.
“Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burdens, and shorter median survivals were more likely to report having EOL conversations.”
Quote in the paperNot a substantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Findingown data
In this study, more than 60% of dying patients did not recall having end-of-life discussions with their physicians.
“In this study, more than 60% of dying patients do not recall having EOL discussions with their physicians.”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Findingnone given
The sample had disproportionately high rates of ethnic minority patients who were highly symptomatic and had poor performance status.
“our sample had disproportionately high rates of ethnic minority patients who were highly symptomatic and had poor performance statuses.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
Propensity-score weighting allowed the primary outcome to be examined independently of observed differences.
“In lieu of a trial, propensity-score weighting enabled us to examine our primary outcome independent of observed differences.”
Quote in the paperSubstantial claim - Study design and conductnone given
Propensity-score weighting cannot correct for unmeasured or hidden biases.
“Although this technique cannot correct for unmeasured or hidden biases, such as how a patients’ prior experiences with death may influence their attitudes to EOL discussions or decision-making”
Quote in the paperSubstantial claim - Interpretationreasoning
Patients appear to benefit more from early hospice referrals.
“suggesting that patients benefit more from early hospice referrals.”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
- Interpretationreasoning
Interventions that reduce aggressive care might lessen bereavement-related distress.
“Our results suggest that bereavement-related distress might be offset by interventions aimed at reducing aggressive care.”
Quote in the paperSubstantial claim - Study design and conductown data
Propensity-score weighting successfully balanced baseline characteristics between patients who reported end-of-life conversations and those who did not.
“Propensity-score weighting successfully adjusted for significant differences in the baseline characteristics of patients who reported EOL conversations and those who did not. After adjustment participants no longer differed by their Karnofsky score, symptom burden, survival time, recruitment site, or religiousness.”
Quote in the paperSubstantial claim - Interpretationown data
End-of-life discussions may produce cascading benefits for patients and their caregivers.
“Our results suggest that EOL discussions may have cascading benefits for patients and their caregivers.”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Premisecitation
Patients and caregivers often disagree in their recall of conversations.
“other studies have revealed that patients are caregivers recall of conversations often disagree.9”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9]
Not checked in the free run.
- Study design and conductown data
Because the data were cross-sectional, causal inferences cannot be made about patients' psychological state at the time of the discussion or their immediate reactions.
“Because our data were cross-sectional, we cannot make causal inferences about patients’ psychological state at the time of the discussion, or their immediate reactions following it.”
Quote in the paperSubstantial claim - Interpretationreasoning
Without independent validation, the accuracy of patients' reported rates of discussions remains unknown.
“Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown”
Quote in the paperSubstantial claim- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Premisecitation
End-of-life discussions are often poorly documented in the medical record.
“Unfortunately, EOL discussions are often poorly documented in the medical record”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9]
Not checked in the free run.
- Premisecitation
Cancer patients frequently misunderstand or fail to recall prognostic discussions, even when they occur.
“Cancer patients frequently misunderstand or fail to recall prognostic discussions, even when they occur.44-47”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [44]
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- cites [45]
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- cites [46]
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- cites [47]
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- Interpretationreasoning
The authors suspect their results underestimate the true prevalence of end-of-life conversations.
“we suspect our results are a conservative estimate of the true point prevalence of EOL conversations.9,46”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [9]
Not checked in the free run.
- cites [46]
Not checked in the free run.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
- Study design and conductnone given
The study used well-validated structured clinical interviews for diagnosing mental disorders.
“One of the strengths of this study is that it includes well validated structured clinical interviews for the diagnosis of mental disorders.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [28]
Not checked in the free run.
- cites [29]
Not checked in the free run.
- May combine two claims. 6
- Classified as probably not a substantial claim. 1
May combine two claims.
Findingown dataPatients who received no aggressive care had a mean quality-of-life score of 6.4, while those who received three or more aggressive therapies had a mean score of 4.6.
“Patients who received no aggressive care had a mean QoL score of 6.4, while patients who received 3 or more therapies had a mean QoL score of 4.6 (F=3.61, df=3, p=0.01).”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
May combine two claims.
Findingown dataPatients with no hospice had a mean quality-of-life score of 5.6; those with one week or less also scored 5.6; those with two months or more scored 6.9.
“Patients who did not receive hospice had a mean QoL score of 5.6; those enrolled for one week or less had a QoL score of 5.6; and those enrolled for 2 months or more had QoL scores of 6.9 (F=4.04, df=3, p=0.008).”
Quote in the paperSubstantial claim- Rests on an assumption: Caregiver report accurately reflects the patient's quality of life near death.
May combine two claims.
Study design and conductreasoningThe study was observational and could not randomize terminally ill cancer patients to end-of-life discussions for ethical and logistical reasons.
“Our findings must be interpreted within the context of an observational study that could not randomize terminally ill cancer patients to EOL discussions for ethical and logistical reasons.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe study did not include interviews with doctors or audio-taped conversations.
“Our study did not include interviews with doctors or audio-taped conversations.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductnone givenPropensity-score weighting is among the most robust available statistical methods for correcting potential selection bias and confounding.
“it is one of the most robust statistical methods available to correct for potential selection bias and confounding.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationPhysicians often avoid end-of-life conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death.
“Physicians also often avoid EOL conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.4,5,10,13,48,49”
Quote in the paperNot a substantial claim0 of 6 sources checked- cites [4]
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- cites [5]
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- cites [10]
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- cites [13]
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- cites [48]
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- cites [49]
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May combine two claims.
InterpretationcitationEnd-of-life discussions may make patients more realistic about the benefits of aggressive therapies, thereby reducing the likelihood of intensive treatments near death.
“EOL discussions may make patients more realistic about the benefits of aggressive therapies, and thereby reduce the likelihood that they receive intensive treatments near death.15,43”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [15]
Not checked in the free run.
- cites [43]
Not checked in the free run.
- Rests on an assumption: Patient self-report accurately identifies whether an end-of-life discussion occurred.
The paper relies on this without support.
Patient self-report accurately identifies whether an end-of-life discussion occurred.
“Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown”
“we do not know who initiated the conversation, when it happened, or what was said.”
The paper relies on this without support.
Caregiver report accurately reflects the patient's quality of life near death.
“In a post-mortem interview, research staff interviewed the formal/informal caregiver involved in the patients’ care during the final week of life to assess the patient’s QoL near death.”
“source of report for patient QoL”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients with advanced cancer commonly misunderstand their prognosis, and such misunderstandings are linked to more futile treatment.
“Misunderstandings about prognosis are common16, 17, 18 and are associated with increased exposure to futile treatments.19, 20, 21, 22”
From 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) (2020) · cites this paper as [20]
The Discussion (page unavailable) says cancer patients frequently misunderstand or fail to recall prognostic discussions. The Results (Medical care at the end-of-life; page unavailable) associate reported end-of-life discussions with fewer aggressive interventions near death, but the study does not establish that prognostic misunderstandings themselves are associated with greater exposure to treatment, or characterize those treatments as futile. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAdvance care planning has been associated with earlier and increased use of hospice care, reduced intensive treatment and hospitalizations at the end of life, and better quality of life in patients with cancer and caregivers.
“Advance care planning has been associated with earlier and increased use of hospice care [12–15], reduced intensive treatment and hospitalizations at the end of life [13, 15–18], and better quality of life in patients with cancer and caregivers [12, 19].”
From Mindfulness to enhance quality of life and support advance care planning: a pilot randomized controlled trial for adults with advanced cancer and their family caregivers. (2024) · cites this paper as [12]
The Results ('Medical care at the end-of-life'; page not supplied) associate end-of-life discussions with longer outpatient hospice enrollment and fewer intensive interventions, including ICU admissions. The Results ('Patients’ Quality of Life at EOL' and 'Bereavement Outcomes'; pages not supplied) link less aggressive care and longer hospice stays to better patient quality of life, and better patient quality of life to better caregiver outcomes. The paper does not establish reduced hospitalizations generally or directly associate the discussions with better quality of life for both patients and caregivers. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEven though survival after starting dialysis is known to be poor, advance care planning is uncommon.
“Despite knowledge of poor survival after dialysis initiation, advance care planning occurs infrequently [9,10].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [10]
Patients want prognostic information and advance care planning, but these happen rarely.
“Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently.”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [10]
ESRD patients who discuss end-of-life care with a clinician are more likely to complete advance directives.
“ESRD patients who have end-of-life discussions with a healthcare provider are more likely to complete advance directives [9,10].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [10]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Hospice-quality-of-life test statistics differ
MinorFor the hospice-stay comparison using quality-of-life scores of 5.6 and 6.9, the abstract reports F=3.70 and p=0.01, while the results report F=4.04 and p=0.008.
“longer hospice stays were associated with better patient QoL (5.6 vs. 6.9; F=3.70, p=0.01)”
“Patients who did not receive hospice had a mean QoL score of 5.6; those enrolled for one week or less had a QoL score of 5.6; and those enrolled for 2 months or more had QoL scores of 6.9 (F=4.04, df=3, p=0.008).”
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“Patients’ functional status and comorbid medical conditions were measured with the Karnofsky score(32) and the Charlson Comorbidity Index, respectively.(33) Quality of life was assessed with the McGill Quality of Life Index’s physical health, symptom, and social support subscales.”
MCHORNEY, C. A., JOHNE, W., & ANASTASIAE, R. (1993) · Medical Care · doi:10.1097/00005650-199303000-00006 · Cited by 6,681 · cited 2× · see citing works
“Interviewers repeated the SCID and MOS SF-36.”
Reducing Bias in Observational Studies Using Subclassification on the Propensity Score
Rosenbaum, P. R., & Rubin, D. B. (1984) · Journal of the American Statistical Association · doi:10.1080/01621459.1984.10478078 · Cited by 3,082 · cited 1× · see citing works
“The predicted probabilities of reporting an end-of-life conversation (propensity scores) were used to derive individual weights equal to the probability of belonging to the opposite group, making the weighted distribution of characteristics among participants in both groups balanced.(37) Therefore, weighted analyses a…”
Steinhauser, K. E. (2000) · JAMA · doi:10.1001/jama.284.19.2476 · Cited by 2,518 · cited 1× · see citing works
“ness (patients who reported that religion was “very important” were coded as “religious”),(22) and the patientphysician relationship.(23) A close patientphysician relationship was defined as one in which patients trusted and respected their physician, felt respected and “seen as a whole person,” and were very comforta…”
Karnofsky, D. A., Abelmann, W. H., Craver, L. F., & Burchenal, J. H. (1948) · Cancer · doi:10.1002/1097-0142(194811)1:4 · Cited by 2,249 · see citing works
The Structured Clinical Interview for DSM-III-R (SCID)
Williams, J. B. W. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820080038006 · Cited by 1,627 · see citing works
Family Perspectives on End-of-Life Care at the Last Place of Care
Teno, J. M. (2004) · JAMA · doi:10.1001/jama.291.1.88 · Cited by 1,492 · cited 1× · see citing works
“The bereavement literature has begun to explore the associations between patients’ place of death, the receipt of hospice care, and caregivers’ subsequent risk for psychiatric disorders.(17,39,40) Recent studies have shown that communication interventions in the intensive care unit can reduce psychological distress am…”
Risk of post-traumatic stress symptoms in family members of intensive care unit patients
Azoulay, E., Pochard, F., Kentish-Barnes, N., Chevret, S., Aboab, J., Adrie, C., Annane, D., Bleichner, G., Bollaert, P. E., Darmon, M., et al. (2005) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200409-1295oc · Cited by 1,332 · cited 1× · see citing works
“The bereavement literature has begun to explore the associations between patients’ place of death, the receipt of hospice care, and caregivers’ subsequent risk for psychiatric disorders.(17,39,40) Recent studies have shown that communication interventions in the intensive care unit can reduce psychological distress am…”
Relationship between cancer patients' predictions of prognosis and their treatment preferences
Weeks, J. C. (1998) · JAMA · doi:10.1001/jama.279.21.1709 · Cited by 1,319 · see citing works
A communication strategy and brochure for relatives of patients dying in the ICU.
Lautrette, A., Darmon, M., Megarbane, B., Joly, L. M., Chevret, S., Adrie, C., Barnoud, D., Bleichner, G., Bruel, C., Choukroun, G., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa063446 · Cited by 1,279 · cited 1× · see citing works
“Recent studies have shown that communication interventions in the intensive care unit can reduce psychological distress among bereaved family members.(41) Our results suggest that bereavement-related distress might be offset by interventions aimed at reducing aggressive care.”
Trends in the Aggressiveness of Cancer Care Near the End of Life
Earle, C. C., Neville, B. A., Landrum, M. B., Ayanian, J. Z., Block, S. D., & Weeks, J. C. (2004) · Journal of Clinical Oncology · doi:10.1200/jco.2004.08.136 · Cited by 990 · cited 1× · see citing works
“This included specific services that have been defined in the literature as indicators of aggressive medical care, including admission to an intensive care unit, ventilation, resuscitation, chemotherapy, or use of a feeding tube near death.(35)”
Balboni, T. A., Vanderwerker, L. C., Block, S. D., Paulk, M. E., Lathan, C. S., Peteet, J. R., & Prigerson, H. G. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2006.07.9046 · Cited by 959 · see citing works
Cancer patients' information needs and information seeking behaviour: in depth interview study
Leydon, G. (2000) · BMJ · doi:10.1136/bmj.320.7239.909 · Cited by 835 · see citing works
The Inner Life of Physicians and Care of the Seriously Ill
Meier, D. E. (2001) · JAMA · doi:10.1001/jama.286.23.3007 · Cited by 677 · cited 1× · see citing works
“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
An Empirical Examination of the Stage Theory of Grief
Maciejewski, P. K., Zhang, B., Block, S. D., & Prigerson, H. G. (2007) · JAMA · doi:10.1001/jama.297.7.716 · Cited by 605 · see citing works
Communicating with realism and hope: incurable cancer patients' views on the disclosure of prognosis
Hagerty, R. G., Butow, P. N., Ellis, P. M., Lobb, E. A., Pendlebury, S. C., Leighl, N., Mac Leod, C., & Tattersall, M. H. N. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.11.138 · Cited by 582 · see citing works
Measurement of Depression in Patients With Cancer
Endicott, J. (1984) · Cancer · doi:10.1002/cncr.1984.53.s10.2243 · Cited by 560 · see citing works
Collusion in doctor-patient communication about imminent death: an ethnographic study
The, A. M., Hak, T., Koëter, G. H., & van der Wal, G. (2000) · BMJ · doi:10.1136/bmj.321.7273.1376 · Cited by 532 · see citing works
Cancer Patient Preferences for Communication of Prognosis in the Metastatic Setting
Hagerty, R. G., Butow, P. N., Ellis, P. A., Lobb, E. A., Pendlebury, S. C., Leighl, N. B., Goldstein, D., Lo, S. K., & Tattersall, M. H. N. (2004) · Journal of Clinical Oncology · doi:10.1200/jco.2004.04.095 · Cited by 504 · see citing works
Cancer Mortality in the United States by Education Level and Race
Albano, J. D., Ward, E., Jemal, A., Anderson, R. N., Cokkinides, V. E., Murray, T., Henley, S. J., Liff, J. M., & Thun, M. J. (2007) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djm127 · Cited by 470 · cited 1× · see citing works
“However, as expected, this cohort was more debilitated (eg, had worse performance status and higher symptom burden) and more likely to have characteristics associated with lower socioeconomic status (eg, be younger, female, uninsured, and identify as a member of an ethnic minority group).(19,20)”
Patient Preferences for Communication with Physicians about End-of-Life Decisions
Hofmann, J. C., Wenger, N. S., Davis, R. B., Teno, J., Connors, A. F., Desbiens, N., Lynn, J., & Phillips, R. S. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-1-199707010-00001 · Cited by 449 · cited 1× · see citing works
“Another study demonstrated that patients who wanted to avoid cardiopulmonary resuscitation and discussed their preferences with physicians were more likely to have do-not-resuscitate orders.(16) Others have shown that hospice is associated with better quality of life near death,(17) and reductions in bereaved caregive…”
Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review
Hancock, K. M., Clayton, J. M., Parker, S. M., der, S. W., Butow, P. N., Carrick, S. E., Currow, D. C., Ghersi, D., Glare, P. A., Hagerty, R. G., et al. (2007) · Palliative Medicine · doi:10.1177/0269216307080823 · Cited by 442 · cited 1× · see citing works
“To date, most of the communications literature in cancer has focused on physicians’ and patients’ preferences surrounding prognostication with little attention paid to the psychological and medical outcomes of these conversations.(38) The bereavement literature has begun to explore the associations between patients’ p…”
Cohen, S. R., Mount, B. M., Bruera, E. D., Provost, M., Rowe, J., & Tong, K. L. (1997) · Palliative Medicine · doi:10.1177/026921639701100102 · Cited by 437 · cited 2× · see citing works
“Quality of life was assessed with the McGill Quality of Life Index’s physical health, symptom, and social support subscales.(31) Caregiver interviews included self-reported sociodemographic characteristics and baseline measures of physical and mental health measures, including the SCID and the Medical Outcomes Study 3…”
Initiating End-of-Life Discussions With Seriously Ill Patients
Quill, T. E. (2000) · JAMA · doi:10.1001/jama.284.19.2502 · Cited by 415 · cited 2× · see citing works
“But these discussions also mean confronting the limitations of medical treatments and the reality that life is finite, both of which may cause psychological distress.(1) Studies suggest that physicians and patients are ambivalent about talking about death and often avoid these conversations.”
Death foretold: prophecy and prognosis in medical care
Lynn, J. (2000) · Choice Reviews Online · doi:10.5860/choice.38-0972 · Cited by 394 · see citing works
Oncologists’ Attitudes Toward and Practices in Giving Bad News: An Exploratory Study
Baile, W. F., Lenzi, R., Parker, P. A., Buckman, R. A., & Cohen, L. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.08.004 · Cited by 366 · see citing works
Hope for the Best, and Prepare for the Worst
Back, A. L., Arnold, R. M., & Quill, T. E. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-5-200303040-00028 · Cited by 364 · cited 1× · see citing works
“By acknowledging that death is near, patients, caregivers, and physicians can focus on clarifying patients’ priorities and improving pain and symptom management.(1,49)”
Caralis, P., Davis, B., Wright, K., et al. (1993) · The Journal of Clinical Ethics · doi:10.1086/jce199304207 · Cited by 359 · see citing works
Palliative and End-of-Life Care in the African American Community
Crawley, L. M. (2000) · JAMA · doi:10.1001/jama.284.19.2518 · Cited by 354 · see citing works
Fried, T. R., Bradley, E. H., & O'Leary, J. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51457.x · Cited by 301 · see citing works
Psychiatric illness in the next of kin of patients who die in the intensive care unit
Siegel, M. D., Hayes, E., Vanderwerker, L. C., Loseth, D. B., & Prigerson, H. G. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e318174da72 · Cited by 292 · cited 1× · see citing works
“The bereavement literature has begun to explore the associations between patients’ place of death, the receipt of hospice care, and caregivers’ subsequent risk for psychiatric disorders.(17,39,40) Recent studies have shown that communication interventions in the intensive care unit can reduce psychological distress am…”
The Role of Chemotherapy at the End of Life: “When Is Enough, Enough?”
Harrington, S. E., & Smith, T. J. (2008) · JAMA · doi:10.1001/jama.299.22.2667 · Cited by 280 · see citing works
‘Hitting you over the head’: Oncologists’ disclosure of prognosis to advanced cancer patients
Gordon, E. J., & Daugherty, C. K. (2003) · Bioethics · doi:10.1111/1467-8519.00330 · Cited by 278 · cited 1× · see citing works
“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
Cherlin, E. J., Fried, T. R., Prigerson, H. G., Schulman‐Green, D., Johnson‐Hürzeler, R., & Bradley, E. H. (2005) · Journal of Palliative Medicine · doi:10.1089/jpm.2005.8.1176 · Cited by 247 · cited 2× · see citing works
“Unfortunately, end-of-life discussions are often poorly documented in the medical record, and other studies have revealed that patients and caregivers recall of conversations are often discrepant.(9) Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown, and we sus…”
Limb salvage for skeletal and soft tissue sarcomas multidisciplinary preoperative therapy
Eilber, F. R., Morton, D. L., Eċkardt, J. J., Grant, T. T., & WEISENBURGER, T. H. (1984) · Cancer · doi:10.1002/1097-0142(19840615)53:12 · Cited by 215 · see citing works
Selman, L. E., Harding, R., Beynon, T., Hodson, F. J., Coady, E., Hazeldine, C., Walton, M. F., Gibbs, L., & Higginson, I. J. (2007) · Heart · doi:10.1136/hrt.2006.106518 · Cited by 194 · see citing works
Necessary Collusion: Prognostic Communication With Advanced Cancer Patients
Helft, P. R. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.07.003 · Cited by 164 · cited 1× · see citing works
“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
“I'm Sorry To Tell You...” Physicians' Reports of Breaking Bad News
Ptacek, J. T., Ptacek, J. J., & Ellison, N. M. (2001) · Journal of Behavioral Medicine · doi:10.1023/a:1010766732373 · Cited by 162 · see citing works
Chu, K. C., Miller, B. A., & Springfield, S. A. (2007) · PubMed Central · doi:10.13016/rrqm-dpmc · Cited by 161 · cited 1× · see citing works
“However, as expected, this cohort was more debilitated (eg, had worse performance status and higher symptom burden) and more likely to have characteristics associated with lower socioeconomic status (eg, be younger, female, uninsured, and identify as a member of an ethnic minority group).(19,20)”
Peaceful Awareness in Patients with Advanced Cancer
Ray, A., Block, S. D., Friedlander, R. J., Zhang, B., Maciejewski, P. K., & Prigerson, H. G. (2006) · Journal of Palliative Medicine · doi:10.1089/jpm.2006.9.1359 · Cited by 159 · see citing works
Mack, J. W., Nilsson, M., Balboni, T., Friedlander, R. J., Block, S. D., Trice, E., & Prigerson, H. G. (2008) · Cancer · doi:10.1002/cncr.23476 · Cited by 155 · see citing works
Collusion in doctor-patient communication about imminent death: an ethnographic study
The, A. M. (2001) · Western Journal of Medicine · doi:10.1136/ewjm.174.4.247 · Cited by 111 · see citing works
Prigerson, H. G. (1992) · Journal of Health and Social Behavior · doi:10.2307/2137315 · Cited by 100 · cited 2× · see citing works
“Consistent with this, a small study showed that end-of-life conversations significantly influenced patients’ understanding that their illness was terminal and that this, in turn, was associated with increased integration of hospice.(15) Another study demonstrated that patients who wanted to avoid cardiopulmonary resus…”
Paradoxes in Cancer Patients' Advance Care Planning
Lamont, E. B., & Siegler, M. A. (2000) · Journal of Palliative Medicine · doi:10.1089/jpm.2000.3.27 · Cited by 97 · see citing works
Kris, A. E., Cherlin, E. J., Prigerson, H. G., Carlson, M. D. A., Johnson‐Hürzeler, R., Kasl, S. V., & Bradley, E. H. (2006) · American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000194642.86116.ce · Cited by 89 · cited 1× · see citing works
“Others have shown that hospice is associated with better quality of life near death,(17) and reductions in bereaved caregivers’ risk of developing major depressive disorder.(18) To date, however, research has not examined whether end-of-life discussions are associated with patients’ medical care in the final week of l…”
Admission to intensive care unit at the end-of-life: is it an informed decision?
Rady, M. Y., & Johnson, D. J. (2004) · Palliative Medicine · doi:10.1191/0269216304pm959oa · Cited by 79 · see citing works
Sullivan, A. M., Lakoma, M. D., Matsuyama, R. K., Rosenblatt, L. A., Arnold, R. M., & Block, S. D. (2007) · Journal of Palliative Medicine · doi:10.1089/jpm.2007.0189 · Cited by 77 · cited 1× · see citing works
“Physicians also often avoid these conversations, communicate euphemistically, are overly optimistic, or delay discussions until patients are close to death, perhaps because their own feelings of failure or loss.(4,5,10,13,47,48) Consistent with this hypothesis, patients with lower Karnofsky scores, higher symptom burd…”
Ethnicity and end-of-life care: the use of feeding tubes.
Gessert, C. E., Curry, N. M., & Robinson, A. (2001) · PubMed · Cited by 59 · see citing works
Communication and understanding of prognosis among stage IV lung and GI cancer patients
Lehmann, L., Shaykevich, S., & Weeks, J. C. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2007.25.18_suppl.9024 · Cited by 3 · cited 2× · see citing works
“Absent such independent validation, the accuracy of patients’ reported rates of discussions remains unknown, and we suspect our results are a conservative estimate of the true point prevalence of end-of-life conversations.(9,42) In addition, it worth noting that our sample had disproportionately high rates of ethnic m…”
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Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010) · BMJ · doi:10.1136/bmj.c1345 · Cited by 2,332 · see citing works
3rd ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 3)
Cardoso, F., Costa, A., Senkus, E., Aapro, M., André, F., Barrios, C. H., Bergh, J. C. S., Bhattacharyya, G. S., Biganzoli, L., Cardoso, M. J., et al. (2016) · Annals of Oncology · doi:10.1093/annonc/mdw544 · Cited by 2,037 · see citing works
Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokaw, F. C., Seville, J., Hull, J. G., Li, Z., Tosteson, T. D., Byock, I. R., et al. (2009) · JAMA · doi:10.1001/jama.2009.1198 · Cited by 1,726 · see citing works
The Clinical Course of Advanced Dementia.
Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., Volicer, L., Givens, J. L., & Hamel, M. B. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0902234 · Cited by 1,618 · see citing works
The effects of advance care planning on end-of-life care: A systematic review
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014) · Palliative Medicine · doi:10.1177/0269216314526272 · Cited by 1,480 · see citing works
Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices
Bernacki, R. E., & Block, S. D. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.5271 · Cited by 1,422 · see citing works
5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5)
Cardoso, F., Paluch-Shimon, S., Senkus, E., Curigliano, G., Aapro, M. S., André, F., Barrios, C. H., Bergh, J., Bhattacharyya, G. S., Biganzoli, L., et al. (2020) · Annals of Oncology · doi:10.1016/j.annonc.2020.09.010 · Cited by 1,369 · see citing works
Azzoli, C. G., Baker, S., Temin, S., Pao, W., Aliff, T., Brahmer, J., Johnson, D. H., Laskin, J. L., Masters, G., Milton, D., et al. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2009.23.5622 · Cited by 915 · see citing works
“In the largest prospective trials of communication, doctors only ever discussed prognosis with their patients with advanced cancer in 38% of cases(179) and only had a conversation about imminent death in 37% of cases.(180)”
BackgroundHealth Care Costs in the Last Week of Life: Associations With End-of-Life Conversations
Zhang, B., Wright, A. A., Huskamp, H. A., Nilsson, M. E., Maciejewski, M. L., Earle, C. C., Block, S. D., Maciejewski, P. K., & Prigerson, H. G. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2008.587 · Cited by 898 · see citing works
Self-citationTemel, J. S., Greer, J. A., El-Jawahri, A. R., Pirl, W. F., Park, E. R., Jackson, V. A., Back, A. L., Kamdar, M. M., Jacobsen, J. C., Chittenden, E., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2016.70.5046 · Cited by 839 · see citing works
“Patients with advanced cancer often fail to understand the intent of their cancer treatment and rarely engage in discussions about their preferences for care at the end of life (EOL).(10,11) Suchmisperceptions are associated withworse EOL-care outcomes.”
BackgroundIntegration of oncology and palliative care: a Lancet Oncology Commission
Kaasa, S., Loge, J. H., Aapro, M., Albreht, T., Anderson, R., Bruera, E. D., Brunelli, C., Caraceni, A. T., Cervantes, A. M. R., Currow, D. C., et al. (2018) · The Lancet Oncology · doi:10.1016/s1470-2045(18)30415-7 · Cited by 834 · see citing works
Decision Making in Advanced Heart Failure
Allen, L. A., Stevenson, L. W., Grady, K. L., Goldstein, N. E., Matlock, D. D., Arnold, R. M., Cook, N. R., Felker, G. M., Francis, G. S., Hauptman, P. J., et al. (2012) · Circulation · doi:10.1161/cir.0b013e31824f2173 · Cited by 818 · see citing works
Mack, J. W., Weeks, J. C., Wright, A. A., Block, S. D., & Prigerson, H. G. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.25.4672 · Cited by 806 · see citing works
“Subjects were recruited as part of the Coping with Cancer Study, a multiinstitutional longitudinal investigation of patients with advanced cancer and their primary (unpaid) caregivers.(4,18) This report describes 325 patients recruited between October 2002 and September 2007 whose self-reported treatment preferences w…”
MethodSelf-citationPalliative Care for the Seriously Ill
Kelley, A. S., & Morrison, R. S. (2015) · New England Journal of Medicine · doi:10.1056/nejmra1404684 · Cited by 817 · see citing works
Wright, A. A., Keating, N. L., Balboni, T. A., Matulonis, U. A., Block, S. D., & Prigerson, H. G. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.26.3863 · Cited by 797 · see citing works
“Coping with Cancer was a prospective, longitudinal, multisite psychiatric epidemiologic study of terminally ill patients with cancer and their informal caregivers designed to determine the rates, causes, and consequences of psychiatric illness in terminally ill patients with cancer and their bereaved caregivers.(13) P…”
MethodSelf-citationEfficacy of advance care planning: a systematic review and meta-analysis.
Houben, C. H. M., Spruit, M. A., Groenen, M. T. J., Wouters, E. F. M., & Janssen, D. J. A. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.01.008 · Cited by 765 · see citing works
Developing Physician Communication Skills For Patient-Centered Care
Levinson, W. S., Lesser, C. S., & Epstein, R. M. (2010) · Health Affairs · doi:10.1377/hlthaff.2009.0450 · Cited by 758 · see citing works
Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care
Yadav, K. N., Gabler, N. B., Cooney, E. L., Kent, S. A., Kim, J., Herbst, N. P., Mante, A., Halpern, S. D., & Courtright, K. R. (2017) · Health Affairs · doi:10.1377/hlthaff.2017.0175 · Cited by 616 · see citing works
Greer, J. A., Pirl, W. F., Jackson, V. A., Muzikansky, A., Lennes, I. T., Heist, R. S., Gallagher, E. R., & Temel, J. S. (2011) · Journal of Clinical Oncology · doi:10.1200/jco.2011.35.7996 · Cited by 575 · see citing works
Mack, J. W., Cronin, A., Keating, N. L., Taback, N., Huskamp, H. A., Malin, J. L., Earle, C. C., & Weeks, J. C. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2012.43.6055 · Cited by 560 · see citing works
“Evidence suggests that less aggressive care is also less costly(31-33) and less burdensome for surviving family members.(3,34) Given the many arguments for less aggressive EOL care, earlier discussions have the potential to change the way EOL care is delivered for patients with advanced cancer and help to assure that…”
Balboni, T., Paulk, M. E., Balboni, M., Phelps, A., Loggers, E., Wright, A., Block, S., Lewis, E., Peteet, J., & Prigerson, H. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.24.8005 · Cited by 442 · see citing works
“These associations were over and above established predictors of EoL care, such as race(29,30) and EoL care preferences.(31,32) Additionally, spiritual care was found to be associated with better patient QoL at the EoL.”
BackgroundSelf-citationMcMahan, R. D., Tellez, I., & Sudore, R. L. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16801 · Cited by 506 · see citing works
Failure to engage hospitalized elderly patients and their families in advance care planning
Heyland, D. K. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.180 · Cited by 496 · see citing works
Availability and Integration of Palliative Care at US Cancer Centers
Hui, D. (2010) · JAMA · doi:10.1001/jama.2010.258 · Cited by 495 · see citing works
Hui, D., Kim, S., Roquemore, J., Dev, R., Chisholm, G. B., & Bruera, E. D. (2014) · Cancer · doi:10.1002/cncr.28628 · Cited by 451 · see citing works
Phelps, A. C. (2009) · JAMA · doi:10.1001/jama.2009.341 · Cited by 465 · see citing works
“When appropriate, clinicians might include chaplains or other trained professionals (eg, liaison psychiatrists(37)) to inquire about religious coping during family meetings while the patient is in an intensive care unit and end-of-life discussions occurring earlier in the disease course.(38) Because aggressive endof-l…”
Hui, D., Hannon, B. L., Zimmermann, C., & Bruera, E. D. (2018) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21490 · Cited by 443 · see citing works
Integrating palliative care into the trajectory of cancer care
Hui, D., & Bruera, E. D. (2015) · Nature Reviews Clinical Oncology · doi:10.1038/nrclinonc.2015.201 · Cited by 425 · see citing works
Lampert, R., Hayes, D. L., Annas, G. J., Farley, M. A., Goldstein, N. E., Hamilton, R. M., Kay, G. N., Kramer, D. B., Mueller, P. S., Padeletti, L., et al. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.04.033 · Cited by 434 · see citing works
Family Perspectives on Aggressive Cancer Care Near the End of Life
Wright, A. A., Keating, N. L., Ayanian, J. Z., Chrischilles, E. A., Kahn, K. L., Ritchie, C. S., Weeks, J. C., Earle, C. C., & Landrum, M. B. (2016) · JAMA · doi:10.1001/jama.2015.18604 · Cited by 425 · see citing works
Self-citationCurtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., Kross, E. K., Reinke, L. F., Feemster, L. C., Edlund, B., et al. (2013) · JAMA · doi:10.1001/jama.2013.282081 · Cited by 426 · see citing works
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End-of-Life Care Discussions Among Patients With Advanced Cancer: A Cohort Study
Mack, J. W., Cronin, A., Taback, N., Huskamp, H. A., Keating, N. L., Malin, J. L., Earle, C. C., & Weeks, J. C. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-3-201202070-00008 · Cited by 420 · see citing works
“Patients 1535 620 Sex† Male 952 (62) 368 (59) Female 583 (38) 252 (41) Race† White 1210 (79) 413 (67) Black 170 (11) 121 (20) Asian 83 (5) 37 (6) Other 69 (4) 47 (8) Missing 3 (0.”
BackgroundInfluentialEndpoints in medical communication research, proposing a framework of functions and outcomes
de Haes, J. C. J. M., & Bensing, J. M. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2008.12.006 · Cited by 411 · see citing works
“Interestingly, a recent study investigating the effectiveness of the provision of an end of life conversation with terminal patients’ turned out to a reduced use of advanced treatment modalities [28].”
BackgroundHui, D., Nooruddin, Z., Didwaniya, N., Dev, R., De La Cruz, M., Kim, S. H., Kwon, J. H., Hutchins, R., Liem, C., & Bruera, E. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2013.02.021 · Cited by 411 · see citing works
Effect of the Serious Illness Care Program in Outpatient Oncology
Bernacki, R., Paladino, J., Neville, B. A., Hutchings, M., Kavanagh, J. E., Geerse, O. P., Lakin, J. R., Sanders, J. J., Miller, K., Lipsitz, S. R., et al. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.0077 · Cited by 383 · see citing works
Bending the Cost Curve in Cancer Care
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“This comorbidity is responsible for poor medical outcomes (Katon, 2011; Kisely, Smith, Lawrence, &Maaten, 2005; Wright et al., 2008), significant decrements in quality of life (Fortin et al.”
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“6% of patients in our study recalled prior prognostic disclosures, particularly considering that 37% of our cohort reported previously discussing their EOL care preferences.(46) This difference suggests that discussing one’s hypothetic EOL preferences may be less threatening than discussing the timeframe of one’s deat…”
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“Such discussions at family meetings lead to lower costs and a lighter family burden (Wright et al. 2008, 2010) and improve family satisfaction and bereavement outcomes (Wright et al. 2008; Zhang et al. 2009).”
BackgroundInfluentialPadeletti, L., Arnar, D. O., Boncinelli, L., Brachman, J., Camm, A. J., Daubert, J., Kassam, S., Deliëns, L., Glikson, M., Hayes, D. L., et al. (2010) · EP Europace · doi:10.1093/europace/euq275 · Cited by 379 · see citing works
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Ethics and end-of-life care for adults in the intensive care unit
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Physician factors associated with discussions about end‐of‐life care
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Communication in palliative care: talking about the end of life, before the end of life
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“Although aggressive medical interventions may be appropriate for, and preferred by, some individuals, patients’ quality of life and relatives’ bereavement adjustment are reported as significantly better when patients receive fewer aggressive medical treatments towards the end-of-life (14).”
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Self-citationPaladino, J., Bernacki, R., Neville, B. A., Kavanagh, J. E., Miranda, S. P., Palmor, M. C., Lakin, J. R., Desai, M. P., Lamas, D. J., Sanders, J. J., et al. (2019) · JAMA Oncology · doi:10.1001/jamaoncol.2019.0292 · Cited by 335 · see citing works
“Outcomes We obtained the secondary outcomes reported herein from EMR review for patients who had died, including (1) proportion of patients with at least 1 documented serious illness conTable 1.”
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Self-citationREMAP: A Framework for Goals of Care Conversations
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Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study
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Referral criteria for outpatient specialty palliative cancer care: an international consensus
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Factors Important to Patients' Quality of Life at the End of Life
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Mack, J. W., & Smith, T. J. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2012.42.4564 · Cited by 299 · see citing works
Bruera, E. D., & Hui, D. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2010.29.5618 · Cited by 307 · see citing works
“At the end of life, the presence of supportive/palliative care might also help patients to avoid unnecessarily harmful therapies that have no chance of meeting their goals of care.(18)”
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Morrison, L. J., Neumar, R. W., Zimmerman, J. L., Link, M. S., Newby, L. K., McMullan, P. W., Hoek, T. L. V., Halverson, C. C., Doering, L. V., Peberdy, M. A., et al. (2013) · Circulation · doi:10.1161/cir.0b013e31828b2770 · Cited by 303 · see citing works
Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients
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Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation
Maves, R. C., Downar, J., Dichter, J. R., Hick, J. L., Devereaux, A. V., Geiling, J. A., Kissoon, N. “., Hupert, N., Niven, A. S., King, M. A., et al. (2020) · CHEST Journal · doi:10.1016/j.chest.2020.03.063 · Cited by 274 · see citing works
Palliative and End-of-Life Care in Stroke
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Winer, E. P., Gralow, J. R., Diller, L., Karlan, B. Y., Loehrer, P. J., Pierce, L. J., Demetri, G. D., Ganz, P. A., Kramer, B. S., Kris, M. G., et al. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2008.21.2134 · Cited by 293 · see citing works
Smith, A. K., McCarthy, E. P., Weber, E. J., Cenzer, I. S., Boscardin, W. J., Fisher, J., & Covinsky, K. E. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.0922 · Cited by 272 · see citing works
Heyland, D. K., Garland, A., Bagshaw, S. M., Cook, D., Rockwood, K. J., Stelfox, H. T., Dodek, P., Fowler, R., Turgeon, A. F., Burns, K. E. A., et al. (2015) · Intensive Care Medicine · doi:10.1007/s00134-015-4028-2 · Cited by 253 · see citing works
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Braun, L. T., Grady, K. L., Kutner, J. S., ADLER, E. D., Berlinger, N., Boss, R. D., Butler, J., Enguidanos, S. M., Friebert, S. E., Gardner, T. J., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000438 · Cited by 270 · see citing works
Curtis, J. R., Nielsen, E. L., Treece, P. D., Downey, L., Dotolo, D., Shannon, S. E., Back, A. L., Rubenfeld, G. D., & Engelberg, R. A. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201006-1004oc · Cited by 269 · see citing works
Racial Disparities in the Outcomes of Communication on Medical Care Received Near Death
Mack, J. W., Paulk, M. E., Viswanath, K., & Prigerson, H. G. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.322 · Cited by 270 · see citing works
Curtis, J. R., Downey, L., Back, A. L., Nielsen, E. L., Paul, S. R., Lahdya, A. Z., Treece, P. D., Armstrong, P., Peck, R., & Engelberg, R. A. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.2317 · Cited by 265 · see citing works
El-Jawahri, A. R., Podgurski, L., Eichler, A. F., Plotkin, S. R., Temel, J. S., Mitchell, S. L., Chang, Y., Barry, M. J., & Volandes, A. E. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2009.24.7502 · Cited by 257 · see citing works
“Previous work has demonstrated that end-of-life discussions are associated with avoidance of CPR and mechanical ventilation near death and with earlier hospice referrals.(25,26) These findings suggest that when patients have a better understanding of their goals-of-care options and the likely outcomes, they tend to op…”
ResultHealth Care Costs for Patients With Cancer at the End of Life
Chastek, B. J., Harley, C., Kallich, J. D., Newcomer, L. N., Paoli, C. J., & Teitelbaum, A. H. (2012) · Journal of Oncology Practice · doi:10.1200/jop.2011.000469 · Cited by 259 · see citing works
Morrison, L., Kierzek, G., Diekema, D., Sayre, M., Silvers, S. M., Idris, A., & Mancini, M. (2010) · Circulation · doi:10.1161/circulationaha.110.970905 · Cited by 243 · see citing works
Schell, J. O., Patel, U. D., Steinhauser, K. E., Ammarell, N., & Tulsky, J. A. (2012) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2011.11.023 · Cited by 252 · see citing works
Machine Learning Approaches to Predict 6-Month Mortality Among Patients With Cancer
Parikh, R. B., Manz, C. R., Chivers, C., Regli, S. H., Braun, J., Draugelis, M. E., Schuchter, L. M., Shulman, L. N., Navathe, A. S., Patel, M. S., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.15997 · Cited by 243 · see citing works
“Features Our data set included 3 broad classes of variables (ie, features) that are commonly available in EHRs: (1) demographic variables (eg, age and sex); (2) Elixhauser comorbidities,24 and (3) laboratory and select electrocardiogram data.”
The Influence of Doctor-Patient Communication on Health Outcomes: A Systematic Review
Riedl, D., & Schüßler, G. (2017) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2017.63.2.131 · Cited by 249 · see citing works
Jackson, V. A., Jacobsen, J. C., Greer, J. A., Pirl, W. F., Temel, J. S., & Back, A. L. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2012.0547 · Cited by 246 · see citing works
Tulsky, J. A., Beach, M. C., Butow, P. N., Hickman, S. E., Mack, J. W., Morrison, R. S., Street, R. L., Sudore, R. L., White, D. B., & Pollak, K. I. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.2005 · Cited by 246 · see citing works
“greatest returns, and (3) map out an agenda for communication research that includes the identification of potential stakeholders and funding sources.”
BackgroundAnderson, R., Bloch, S., Armstrong, M., Stone, P. C., & Low, J. (2019) · Palliative Medicine · doi:10.1177/0269216319852007 · Cited by 240 · see citing works
El‐Jawahri, A., Traeger, L., Park, E. R., Greer, J. A., Pirl, W. F., Lennes, I. T., Jackson, V. A., Gallagher, E. R., & Temel, J. S. (2014) · Cancer · doi:10.1002/cncr.28369 · Cited by 240 · see citing works
Sudore, R. L., Boscardin, W. J., Feuz, M. A., McMahan, R. D., Katen, M. T., & Barnes, D. E. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.1607 · Cited by 236 · see citing works
Comfort Care for Patients Dying in the Hospital
Blinderman, C. D., & Billings, J. A. (2015) · New England Journal of Medicine · doi:10.1056/nejmra1411746 · Cited by 244 · see citing works
Sinuff, T., Dodek, P., You, J. J., Barwich, D., Tayler, C., Downar, J., Hartwick, M., Frank, C., Stelfox, H. T., & Heyland, D. K. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.12.007 · Cited by 241 · see citing works
Perceived stigma among individuals with common mental disorders
Alonso, J., Burón, A., Rojas‐Farreras, S., de Graaf, R., Haro, J. M., de Girolamo, G., Bruffaerts, R., Kovess–Masféty, V., Matschinger, H., & Vilagut, G. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.02.006 · Cited by 235 · see citing works
“Work and role limitation in themonth prior to the interview was assessed by the WHODAS-II (Wright et al., 2008).”
MethodDiscussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced Cancer
Epstein, A. S., Prigerson, H. G., O'Reilly, E. M., & Maciejewski, P. K. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2015.63.6696 · Cited by 232 · see citing works
“When you think about this, do you think in terms of (select response)?” Response options were (1) months, (2) years, and (3) do not know.”
BackgroundMethodInfluentialLo, C., Zimmermann, C., Rydall, A., Walsh, A., Jones, J. M., Moore, M. J., Shepherd, F. A., Gagliese, L., & Rodin, G. (2010) · Journal of Clinical Oncology · doi:10.1200/jco.2009.26.9712 · Cited by 228 · see citing works
Oonk, M. H. M., Planchamp, F., Baldwin, P., Mahner, S., Mirza, M. R., Fischerová, D., Creutzberg, C. L., Guillot, E., Garganese, G., Lax, S., et al. (2023) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2023-004486 · Cited by 235 · see citing works
Family-Centered Advance Care Planning for Teens With Cancer
Lyon, M. E., Jacobs, S., Briggs, L., Cheng, Y. I., & Wang, J. (2013) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2013.943 · Cited by 223 · see citing works
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Forman, D. E., Rich, M. W., Alexander, K. P., Zieman, S., Maurer, M. S., Najjar, S. S., Cleveland, J. C., Krumholz, H. M., & Wenger, N. K. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.02.014 · Cited by 228 · see citing works
“Open discussion about mortality can help ease feelings of isolation, depression, and even selfblame for treatment failure among patients nearing the end of life (64).”
An introduction to advance care planning in practice
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Sobański, P., Alt‐Epping, B., Currow, D. C., Goodlin, S. J., Grodzicki, T. K., Hogg, K. J., Janssen, D. J. A., Johnson, M. J., Krajnik, M., Leget, C. J. W., et al. (2019) · Cardiovascular Research · doi:10.1093/cvr/cvz200 · Cited by 214 · see citing works
de Graaf, J., van Lingen, R. A., Simons, S. H. P., Anand, K. J. S., Duivenvoorden, H. J., Weisglas‐Kuperus, N., Roofthooft, D. W. E., Jebbink, L. J. G., Veenstra, R., Tibboel, D., et al. (2011) · Pain · doi:10.1016/j.pain.2011.02.017 · Cited by 214 · see citing works
“Flowchart o literature were combined into a propensity score to correct for baseline imbalance [55].”
MethodTimely Palliative Care: Personalizing the Process of Referral
Hui, D., Heung, Y. J., & Bruera, E. D. (2022) · Cancers · doi:10.3390/cancers14041047 · Cited by 215 · see citing works
Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review
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The Very Elderly Admitted to ICU
Heyland, D. K., Cook, D., Bagshaw, S. M., Garland, A., Stelfox, H. T., Mehta, S., Dodek, P., Kutsogiannis, J., Burns, K. E. A., Muscedere, J., et al. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000001024 · Cited by 179 · see citing works
Advance Care Planning Beyond Advance Directives: Perspectives From Patients and Surrogates
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“Yet, decision making is often stressful for both patients and surrogates and many feel unprepared to make informed choices (3-9).”
BackgroundEngaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning
Sudore, R. L., Schillinger, D., Katen, M. T., Shi, Y., Boscardin, W. J., Osua, S., & Barnes, D. E. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.4657 · Cited by 200 · see citing works
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- Authors
- Wright, A. A.
- Affiliations
- Dana-Farber Cancer Institute (US)
- Corresponding author
- Wright, Alexi A.
- ORCID
- Wright, Alexi A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2008-10-08
- Volume
- 300
- Issue
- 14
- Pages
- 1665
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC2853806
- OpenAlex
- W2137401089
- Cited by
- 2,788
- References
- 50
- Citations by year
- 2026: 115 · 2025: 132 · 2024: 152 · 2023: 167 · 2022: 186 · 2021: 221 · 2020: 215 · 2019: 225 · 2018: 178 · 2017: 207 · 2016: 179 · 2015: 159 · 2014: 143 · 2013: 136 · 2012: 110
- FWCI
- 84.45
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (acceptedVersion)
- Funders
- McGill University
- National Institute on Aging (K24AG033640)
- National Institute of Mental Health (MH-63892, R01MH063892)
- National Cancer Institute (R01CA106370, CA106370, CA 92044343, T32CA009172)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- end-of-life discussions, advance care planning, mechanical ventilation, cardiopulmonary resuscitation, hospice enrollment, advanced cancer, patient mental health, major depressive disorder, informal caregivers, quality of life, intensive care unit admission, physician-patient communication, patient autonomy
- MeSH terms
- Adaptation, Psychological, Aged, Attitude to Death, Bereavement, Female, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Neoplasms, Physician-Patient Relations, Physician's Role, Quality of Life, Resuscitation, Terminal Care, Caregivers, Hospice Care, Terminally Ill, Advance Care Planning
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