The Association between Chronic Conditions, End-of-Life Health Care Use, and Documentation of Advance Care Planning among Patients with Cancer
Open accessAbstract
Background: Multiple chronic conditions (MCCs) are associated with increased intensity of end-of-life (EOL) care, but their effect is not well explored in patients with cancer. Objective: We examined EOL health care intensity and advance care planning (ACP) documentation to better understand the association between MCCs and these outcomes. Design: Retrospective cohort study. Setting/Subjects: Patients aged 18+ years at UW Medicine who died during 2010–2017 with poor prognosis cancer, with or without chronic liver disease, chronic pulmonary disease, coronary artery disease, dementia, diabetes with end-stage organ damage, end-stage renal disease, heart failure, or peripheral vascular disease. Measurements: ACP documentation 30+ days before death, in-hospital death, and inpatient or intensive care unit (ICU) admission in the last 30 days. We performed logistic regression for outcomes. Results: Of 15,092 patients with cancer, 10,596 (70%) had 1+ MCCs (range 1–8). Patients with cancer and heart failure had highest odds of hospitalization (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.46–1.91), ICU admission (OR 2.06, 95% CI 1.76–2.41), or in-hospital death (OR 1.62, 95% CI 1.43–1.84) versus patients with cancer and other conditions. Patients with ACP 30+ days before death had lower odds of in-hospital death (OR 0.65, 95% CI 0.60–0.71), hospitalization (OR 0.67, 95% CI 0.61–0.74), or ICU admission (OR 0.71, 95% CI 0.64–0.80). Conclusions: Patients with ACP 30+ days before death had lower odds of high-intensity EOL care. Further research needs to explore how to best use ACP to ensure patients receive care aligned with patient and family goals for care.
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Advance 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].”
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- Authors
- McDermott, C. L., Engelberg, R. A., Sibley, J., Sorror, M. L., & Curtis, J. R.
- Affiliations
- University of Washington (US)
- Corresponding author
- McDermott, Cara L.
- Venue
- Journal of Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2020-09-22
- Volume
- 23
- Issue
- 10
- Pages
- 1335-1341
- ISSN
- 1096-6218 (ISSN-L)
- 1557-7740
- PMC
- PMC7523017
- OpenAlex
- W3011884898
- Cited by
- 31
- References
- 35
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 3
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Palliative Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cambia Health Foundation
- National Institutes of Health
- National Heart, Lung, and Blood Institute (K12HL137940)
- National Institute of Nursing Research (U2CNR014637, U24NR014637)
- 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 › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- advance care planning, end-of-life care, multimorbidity, cancer, advance care planning documentation, in-hospital mortality, intensive care unit admission, hospitalization, heart failure, poor-prognosis cancer
- MeSH terms
- Chronic Disease, Death, Delivery of Health Care, Documentation, Humans, Neoplasms, Retrospective Studies, Terminal Care, Hospital Mortality, Advance Care Planning
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