Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

Starr, Lauren T.; Ulrich, Connie M.; Corey, Kristin L.; Meghani, Salimah H.

doi:10.1177/1049909119848148

Cited by 132Palliative Care and End-of-Life IssuesPalliative and Oncologic CarePain Management and Opioid Use

Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

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Starr, Lauren T., Ulrich, Connie M., Corey, Kristin L., Meghani, Salimah H.·2019·American Journal of Hospice and Palliative Medicine®

DOI 10.1177/1049909119848148PMC PMC6711813

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Abstract

Background: Aggressive end-of-life (EOL) care is associated with lower quality of life and greater regret about treatment decisions. Higher EOL costs are also associated with lower quality EOL care. Advance care planning and goals-of-care conversations (“EOL discussions”) may influence EOL health-care utilization and costs among persons with cancer. Objective: To describe associations among EOL discussions, health-care utilization and place of death, and costs in persons with advanced cancer and explore variation in study measures. Methods: A systematic review was conducted using PubMed, Embase, and CINAHL. Twenty quantitative studies published between January 2012 and January 2019 were included. Results: End-of-life discussions are associated with lower health-care costs in the last 30 days of life (median US$1048 vs US$23482; P < .001); lower likelihood of acute care at EOL (odds ratio [(OR] ranging 0.43-0.69); lower likelihood of intensive care at EOL (ORs ranging 0.26-0.68); lower odds of chemotherapy near death (ORs 0.41, 0.57); lower odds of emergency department use and shorter length of hospital stay; greater use of hospice (ORs ranging 1.79 to 6.88); and greater likelihood of death outside the hospital. Earlier EOL discussions (30+ days before death) are more strongly associated with less aggressive care outcomes than conversations occurring near death. Conclusions: End-of-life discussions are associated with less aggressive, less costly EOL care. Clinicians should initiate these discussions with patients having cancer earlier to better align care with preferences.

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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].”
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 [13]
The Results (Summary of Findings; page unavailable) associate earlier end-of-life discussions with longer hospice enrollment and report greater hospice use, less aggressive care, and fewer hospitalizations. The Conclusions also link these care outcomes to greater quality of life, but the paper does not establish the claimed improvement in quality of life for both patients with cancer and caregivers. (LLM, conf=0.88)
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A taxonomy of the factors contributing to the overtreatment of cancer patients at the end of life. What is the problem? Why does it happen? How can it be addressed?
Cherny, N. I., Nortjé, N., Kelly, R., Zimmermann, C., Jordan, K., Kreye, G., Le, N., & Adelson, K. B. (2025) · ESMO Open · doi:10.1016/j.esmoop.2024.104099 · Cited by 28 · see citing works
Evaluating outcomes of advance care planning interventions for adults living with advanced illness and people close to them: A systematic meta-review
Crooks, J., Rizk, N., Greene, C., Hopwood, G., Smith, O., Seddon, K., & Hudson, B. F. (2025) · Palliative Medicine · doi:10.1177/02692163251344428 · Cited by 27 · see citing works
Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations
von Blanckenburg, P., Leppin, N., Nagelschmidt, K., Seifart, C., & Rief, W. (2021) · Psychotherapy and Psychosomatics · doi:10.1159/000511199 · Cited by 26 · see citing works
End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model
Levoy, K. N., Tarbi, E. C., & Santis, J. P. D. (2020) · Nursing Outlook · doi:10.1016/j.outlook.2020.07.008 · Cited by 27 · see citing works
Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature
Davidoff, A. J., Akif, K. E., & Halpern, M. T. (2022) · JNCI Monographs · doi:10.1093/jncimonographs/lgac011 · Cited by 27 · see citing works
Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake
Guccione, L., Fullerton, S., Gough, K., Hyatt, A., Tew, M., Aranda, S. K., & Francis, J. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1040589 · Cited by 25 · see citing works
Early Integrated Palliative Care Within a Surgical Oncology Clinic
Bansal, V. V., Kim, D., Reddy, B., Witmer, H. D. D., Dhiman, A., Godley, F. A., Ong, C. T., Clark, S., Ulrich, L., Polite, B. N., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.41928 · Cited by 24 · see citing works
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.
Mosher, C. E., Beck-Coon, K. A., Wu, W., Lewson, A. B., Stutz, P. V., Brown, L. F., Tang, Q., Helft, P. R., Levoy, K., Hickman, S. E., et al. (2024) · BMC Palliative Care · doi:10.1186/s12904-024-01564-7 · Cited by 23 · see citing works
“Advance care planning has been associated with earlier and increased use of hospice care [12–15], reduced intensive treat-ment and hospitalizations at the end of life [13, 15– 18], and better quality of life in patients with cancer and caregivers [12, 19].”
Background
A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings
Lo, J. J.-M., Graves, N., Chee, J. H., & Hildon, Z. J. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01071-7 · Cited by 21 · see citing works
Association between advanced care planning and emergency department visits: A systematic review
Sakamoto, A., Inokuchi, R., Iwagami, M., Sun, Y., & Tamiya, N. (2023) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2023.03.004 · Cited by 21 · see citing works
Exploring advance care planning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study
Rodi, H., Detering, K. M., Sellars, M., Macleod, A., Todd, J., Fullerton, S., Waller, A. E., & Nolte, L. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05878-z · Cited by 21 · see citing works
Perceptions on the current content and pedagogical approaches used in end-of-life care education among undergraduate nursing students: a qualitative, descriptive study
Cao, W., Li, C., Zhang, Q., & Tong, H. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03625-y · Cited by 19 · see citing works
Interventions to promote readiness for advance care planning: A systematic review and meta-analysis
Tan, M., Tang, S., Feder, S. L., Xiao, J., Huang, C., Cook, A. G., Johnson, C. E., & Ding, J. (2024) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2024.104778 · Cited by 18 · see citing works
Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers
Tönnies, J., Hartmann, M., Jäger, D., Bleyel, C., Becker, N., Friederich, H., & Haun, M. W. (2021) · Frontiers in Oncology · doi:10.3389/fonc.2021.673147 · Cited by 17 · see citing works
Death education interventions for people with advanced diseases and/or their family caregivers: A scoping review
Wang, T., Cheung, K., & Cheng, H. (2024) · Palliative Medicine · doi:10.1177/02692163241238900 · Cited by 16 · see citing works
Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients
Starr, L. T., Ulrich, C. M., Junker, P., Appel, S. M., O’Connor, N. R., & Meghani, S. H. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.05.020 · Cited by 16 · see citing works
Self-citation
Augmented Intelligence to Predict 30-day Mortality in Patients with Cancer
Gajra, A., Zettler, M. E., Miller, K. A., Blau, S. H., Venkateshwaran, S. S., Sridharan, S., Showalter, J., Valley, A. W., & Frownfelter, J. (2021) · Future Oncology · doi:10.2217/fon-2021-0302 · Cited by 14 · see citing works
Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers
Ou, J. Y., Waters, A. R., Kaddas, H. K., Warner, E. L., Lopez, P. L. V., Mann, K., Anderson, J. S., Ray, N., Tsukamoto, T., Gill, D. M., et al. (2022) · Journal of Cancer Survivorship · doi:10.1007/s11764-022-01214-y · Cited by 14 · see citing works
Evaluation of a Large Scale Advance Care Planning Co-Design Education Program for Chinese-Speaking People in Australia
Wong, A. K. Y., Collins, A., Ng, A., Buizen, L., Philip, J. A. M., & Le, B. H. C. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091211014833 · Cited by 13 · see citing works
Factors Associated with Health Care Utilization at the End of Life for Patients with Acute Myeloid Leukemia
Vaughn, D. M., Johnson, P. C., Jagielo, A. D., Topping, C., Reynolds, M. J., Kavanaugh, A. R., Webb, J. A., Fathi, A., Hobbs, G. S., Brunner, A. M., et al. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0249 · Cited by 12 · see citing works
End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy
Formoso, G., Marino, M., Guberti, M., & Grilli, R. G. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057437 · Cited by 13 · see citing works
Immunotherapy Versus Hospice: Treatment Decision-Making in the Modern Era of Novel Cancer Therapies
An, A. W., & Hui, D. (2022) · Current Oncology Reports · doi:10.1007/s11912-022-01203-5 · Cited by 11 · see citing works
A Pilot Study of the Effects of COMPLETE: A Communication Plan Early Through End of Life, on End-of-Life Outcomes in Children With Cancer
Moody, K. M., Hendricks‐Ferguson, V. L., Baker, R. A., Perkins, S. M., & Haase, J. E. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.03.033 · Cited by 11 · see citing works
End-of-Life Communication in the Emergency Department
Zhang, Y. H., Silva, M. W. S. D., Allen, J. C., Lateef, F., & Omar, E. B. (2022) · Journal of Emergencies Trauma and Shock · doi:10.4103/jets.jets_80_21 · Cited by 11 · see citing works
Advance Care Planning and Attainment of Cancer Patients’ End-of-Life Preferences: Relatives’ Perspective
Bar‐Sela, G., Tur‐Sinai, A., Schaham, N. G., & Bentur, N. (2022) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091221099921 · Cited by 10 · see citing works
Financial hardship for patients with cancer and caregivers at end of life in the USA: narrative review
Salazar, M. M., Khera, N., Chino, F. L., & Johnston, E. E. (2023) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2023-004556 · Cited by 10 · see citing works
Variation in hospital utilization of palliative interventions for patients with advanced gastrointestinal cancer near end of life
Chen, V. W., Portuondo, J. I., Cooper, Z. R., & Massarweh, N. N. (2022) · Journal of Surgical Oncology · doi:10.1002/jso.27177 · Cited by 10 · see citing works
Factors influencing decision-making processes for intensive care therapy goals: A systematic integrative review
Kelly, D. N., Barrett, J. A., Brand, G., Leech, M. T., & Rees, C. E. (2024) · Australian Critical Care · doi:10.1016/j.aucc.2024.02.007 · Cited by 9 · see citing works
Healthcare use and healthcare costs for patients with advanced cancer; the international ACTION cluster-randomised trial on advance care planning
Korfage, I. J., Polinder, S., Preston, N. J., van Delden, J. J. M., Geraerds, S. J. L. M., Dunleavy, L., Faes, K., Miccinesi, G., Carreras, G., Arnfeldt, C. M., et al. (2022) · Palliative Medicine · doi:10.1177/02692163221142950 · Cited by 9 · see citing works
The Challenges of Advance Care Planning for Acute Care Registered Nurses
Rietze, L., Stajduhar, K., Purkis, M. E., & Cloutier, D. (2024) · Canadian Journal of Nursing Research · doi:10.1177/08445621241244532 · Cited by 9 · see citing works
End-of-life care quality for American Indians with cancer
Emerson, M. A., Spees, L. P., Jackson, B. E., Fariman, S., Begay, J. A., Morris, H. N., Salas, A. I., Baggett, C. D., Akinyemiju, T., Bell, R. A., et al. (2025) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djaf007 · Cited by 8 · see citing works
Cost impact of introducing a treatment escalation/limitation plan during patients’ last hospital admission before death
Bouttell, J., Gonzalez, N. J., Geue, C., Lightbody, C. J., & Taylor, D. R. (2020) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzaa132 · Cited by 7 · see citing works
Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
da Silva, C. M. D., Germano, J. N., Costa, A. K. D. A., Gennari, G. A., Caruso, P., & Nassar, A. P. (2023) · Internal and Emergency Medicine · doi:10.1007/s11739-023-03216-9 · Cited by 8 · see citing works
Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer
Gray, T. F., Plotke, R. L., Heuer, L. B., Topping, C. E. W., Nipp, R. D., Wang, A. C., Banda, J. G., Greer, J. A., Temel, J. S., & El-Jawahri, A. R. (2023) · Palliative Medicine · doi:10.1177/02692163231155511 · Cited by 8 · see citing works
Effectiveness of a facilitation programme using a mobile application for initiating advance care planning discussions between patients with advanced cancer and healthcare providers: protocol for a randomised controlled trial (J-SUPPORT 2104)
Obama, K., Fujimori, M., Okamura, M., Kadowaki, M., Ueno, T., Boku, N., Mori, M., Akechi, T., Yamaguchi, T., Oyamada, S., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-069557 · Cited by 7 · see citing works
Patients’, families’ and healthcare providers’ perspectives on end-of-life communication in Chinese hospital settings: A qualitative study protocol
Chen, W., Chung, J. O. K., Lam, K. K. W., & Molassiotis, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0296342 · Cited by 7 · see citing works
Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study
Wang, C.-L., Liu, Y., Gao, Y.-L., Li, Q., Liu, Y.-C., & Chai, Y.-F. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-075714 · Cited by 7 · see citing works
Intensity of end‐of‐life care for dual‐eligible beneficiaries with cancer and the impact of delivery system affiliation
Herrel, L. A., Zhu, Z., Ryan, A. M., Hollenbeck, B. K., & Miller, D. C. (2021) · Cancer · doi:10.1002/cncr.33874 · Cited by 7 · see citing works
Needs and health-related quality of life domains relevant to people in Europe with advanced cancer in need of palliative care: a systematic review of qualitative research
Lizano-Barrantes, C., Amat-Fernández, C., Garín, O., Luer-Aguila, R., Pardo, Y., Rojas-Concha, L., Thong, M. S. Y., Apolone, G., Brunelli, C., Caraceni, A. T., et al. (2026) · Quality of Life Research · doi:10.1007/s11136-025-04129-0 · Cited by 6 · see citing works
Advance care planning at life milestones
Ludwick, R. E., Bakerjian, D., Zalon, M. L., Melander, S. D., & Crist, J. D. (2022) · Nursing Outlook · doi:10.1016/j.outlook.2022.02.011 · Cited by 6 · see citing works
Methodological aspects of economic evaluations conducted in the palliative or end of life care settings: a systematic review protocol
Fischer, C., Chwala, E., & Simon, J. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035760 · Cited by 6 · see citing works
End-of-life discussions reduce the utilization of life-sustaining treatments during the last three months of life in cancer patients
Chan, S.-Y., Lai, Y., Chen, Y., Chiang, S.-J., Tsai, Y.-F., Hsu, L., Chuang, P., Chen, C.-C., & Yen, Y. (2022) · Scientific Reports · doi:10.1038/s41598-022-11586-x · Cited by 6 · see citing works
Health care utilization among patients with oesophageal and gastric cancer: the impact of initial treatment strategy and assignment of a contact nurse
Dalhammar, K., Malmström, M., Sandberg, M., Falkenback, D., & Kristensson, J. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-07042-7 · Cited by 6 · see citing works
Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
da Silva, C. M. D., Besen, B. A. M. P., & Nassar, A. P. (2023) · Journal of Critical Care · doi:10.1016/j.jcrc.2023.154468 · Cited by 5 · see citing works
Intensity of end-of-life care for gynecologic cancer patients by primary oncologist specialty
Hicks-Courant, K., Kanter, G. P., Schapira, M. M., Brensinger, C. M., Liu, Q., & Ko, E. M. (2022) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2021-003285 · Cited by 5 · see citing works
End-of-life care discussions with healthcare providers and dying experiences: A latent class analysis using the health and retirement study
Lou, Y. (2023) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2023.105319 · Cited by 4 · see citing works
End-of-life in Hepatocellular Carcinoma
Goble, S. R., Sultan, A., & Debes, J. D. (2024) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000002091 · Cited by 4 · see citing works
Nurse Educators Establish and Evaluate Community Coalition to Promote Statewide Advance Care Planning Through RE-AIM
Kupershmidt, S., Fischbach, C., Hegge, H., AbouSamra, H., Penisten, L., & Dieter, C. (2020) · Journal of Hospice and Palliative Nursing · doi:10.1097/njh.0000000000000662 · Cited by 4 · see citing works
Goals of care discussions: perceptions of radiation and medical oncologists
Hong, D. Y., Das, L. C., Daily, E., Levine, S. K., Hahn, O. M., Liauw, S. L., Golden, D. W., & Son, C. H. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06258-x · Cited by 4 · see citing works
Disparities in the medical expenditures of patients with cancer and concomitant mental disorder: analyzing the effects of diagnosis sequence order
Ma, K.-J., Su, S.-Y., Nie, D., Chung, W., Yao, C.-Y., & Wang, J. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09056-9 · Cited by 4 · see citing works
Interventions Performed in Children With Immunocompromised Conditions in the Pediatric Intensive Care Unit Within 48 Hours of Death
Kegel, A., Espinoza, J., Rahrig, A., Willis, T. S., & Rowan, C. M. (2024) · Journal of Palliative Medicine · doi:10.1089/jpm.2023.0400 · Cited by 4 · see citing works
Question prompt list intervention for patients with advanced cancer: a systematic review and meta-analysis
Wang, S., Hu, W., & Chang, Y. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08432-3 · Cited by 5 · see citing works
Expectations in the Communication About Death and Dying: Development and Initial Validation of the End-of-Life Conversations – Expectations Scale
Bendel, Y., Pinquart, M., Schulz-Quach, C., & von Blanckenburg, P. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221110726 · Cited by 5 · see citing works
Elements of End-of-Life Discussions Associated With Patients’ Reported Outcomes and Actual End-of-Life Care in Patients With Pretreated Lung Cancer
Hasegawa, T., Okuyama, T., Uemura, T., Matsuda, Y., Otani, H., Shimizu, J., Horio, Y., Watanabe, N., Yamaguchi, T., Fukuda, S., et al. (2023) · The Oncologist · doi:10.1093/oncolo/oyad245 · Cited by 4 · see citing works
Association Between Systemic Anticancer Therapy Administration Near the End of Life With Health Care and Hospice Utilization in Older Adults: A SEER Medicare Analysis of End-of-Life Care Quality
Canavan, M., Cheng, L., Xiang, J. J., Lin, J. K., Hui, D., Zhao, H., Nortjé, N., Ratan, R., Cherny, N. I., Pham, T. H.-T., et al. (2025) · Journal of Clinical Oncology · doi:10.1200/jco-25-00530 · Cited by 4 · see citing works
Best practices for communication of prognosis and end-of-life discussions with patients with advanced breast cancer: A report from the advanced breast cancer global alliance
Fallowfield, L. J., Kiely, B. E., Travado, L., Ventura, R., Dullehan, J., & Cardoso, F. (2025) · The Breast · doi:10.1016/j.breast.2025.104595 · Cited by 3 · see citing works
Guidelines for goals of care discussions in patients with gynecologic cancer
Peters, P., Havrilesky, L. J., & Davidson, B. A. (2023) · Gynecologic Oncology · doi:10.1016/j.ygyno.2023.05.016 · Cited by 3 · see citing works
Evaluation of Direct Medical Costs and Associated Factors Within the Last 30 days of Life of Hospitalized Cancer Patients
Süffert, S. C. I., Motke, B. B., Linhares, A. B., Vargens, A. F., Alano, T. S., Lutz, A. T., Borges, R. B., Bica, C. G., & Alves, R. J. V. (2022) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091221147906 · Cited by 3 · see citing works
Better than expected? Predictors of coping with expectation violations in the communication about death and dying
Bendel, Y., Gesualdo, C., Pinquart, M., & von Blanckenburg, P. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1256202 · Cited by 2 · see citing works
The Current Status of Palliative Care, Hospice, and End-of-Life Health Care Utilization in Patients With Malignant Ureteral Obstruction
Felice, M. D., Koehne, E. L., Patel, H. D., Elliott, N., Hekman, L., Lewer, O., Rahman, F., Petix, S., Ellis, J. L., & Santos, G. D. (2023) · Urology Practice · doi:10.1097/upj.0000000000000472 · Cited by 3 · see citing works
Effects of hospice-shared care on terminal cancer patients in Taiwan: A hospital-based observational study
Huang, H.-W., Liu, C., Tung, T., & Liu, L. (2024) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2024.102525 · Cited by 3 · see citing works
Perceptions and experiences of onco-haematology professionals in relation to advance care planning: a qualitative study
Lasmarías, C., Aradilla‐Herrero, A., Silva, N., & Trelis, J. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08371-z · Cited by 3 · see citing works
Patient‐Reported Goals of Care in the Preoperative Clinic: Barriers to and Facilitators of Patient Values Elicitation and Documentation
Rosen, R. Y., Bartsch, C., Thompson, E., Letica‐Kriegel, A. S., Kaur, Y., Ng, S., Vaynrub, M., Rosa, W. E., Broach, V. A., Epstein, A. S., et al. (2024) · Journal of Surgical Oncology · doi:10.1002/jso.27974 · Cited by 3 · see citing works
Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study
Anaka, M., Lee, M., Lim, E., Ghosh, S., Cheung, W. Y., & Spratlin, J. (2022) · JCO Oncology Practice · doi:10.1200/op.21.00649 · Cited by 3 · see citing works
End-of-life interventions in patients with cancer
Webber, C., Hafid, S., Gayowsky, A., Howard, M., Tanuseputro, P., Jones, A., Scott, M., Hsu, A. T., Downar, J., Manuel, D. G., et al. (2023) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2023-004222 · Cited by 2 · see citing works
Are specialist-provided end-of-life scenarios key to initiation of advance care planning in primary care? A mixed-methods study
Poelman, S. W., Ermers, D. J. M., Schers, H., Vissers, K. C. P., Veldhoven, C. M. M., Kuip, E. J. M., & Perry, M. (2024) · Palliative & Supportive Care · doi:10.1017/s1478951523002055 · Cited by 2 · see citing works
Improving End-of-Life Care through AI-Based Clinical Decision Support
Saleska, J. L., Moore, N. H., Pitzer, K., Foraker, R. E., & White, P. (2025) · NEJM Catalyst · doi:10.1056/cat.24.0392 · Cited by 2 · see citing works
Using Human-Centered Design to Improve Serious Illness Care for Older Adults With Advanced Dementia
Chehab, L. Z., Goitiandia, S. W., Pereira, L. M., Jung, K., Chen, A., Patel, D., Axelrod, J. K., Li, L., Williams, I., Dohan, D. P., et al. (2024) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2024.11.015 · Cited by 2 · see citing works
Advance Care Planning Billing Codes Associated With Decreased Healthcare Utilization in Neurological Disease
Brown, G. M., Jesus, S. D., Leboffe, E., Esch, A., & Newport, K. B. (2024) · Journal of Healthcare Management · doi:10.1097/jhm-d-23-00234 · Cited by 2 · see citing works
The Impact of Advanced Care Planning on Hospice Utilization in Patients with Cancer: A Nationwide Analysis in Korea
Kim, W., Kim, B., Kim, M., & Choi, J. (2025) · Cancers · doi:10.3390/cancers17091471 · Cited by 2 · see citing works
Relevance and consequence of economic and social resources of severely ill persons and their informal caregivers at the end-of-life: a systematic review of qualitative studies
Matzinger, M., Baum, E., Bernhardsgrütter, D., Kesseli, M., Michelak, G., Orosaj, F., Kobleder, A., & Vetsch, J. (2025) · BMC Palliative Care · doi:10.1186/s12904-025-01961-6 · Cited by 2 · see citing works
Do-Not-Resuscitate Orders and Outcomes for Patients with Pancreatic Cancer
Hao, Q., Segel, J. E., Gusani, N. J., & Hollenbeak, C. S. (2022) · Journal of Pancreatic Cancer · doi:10.1089/pancan.2022.0006 · Cited by 2 · see citing works
Increase in hospital care at the end of life: Retrospective analysis of the last 20 years of life of a cohort of patients
Jiménez-Puente, A., Escalante, M. D. M., Martos, F., & García‐Alegría, J. (2024) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2024.101484 · Cited by 1 · see citing works
Existenzielle Kommunikation – Schlagwort oder wichtiges Werkzeug?
Kappauf, H. W. (2024) · Die Onkologie · doi:10.1007/s00761-024-01618-8 · Cited by 1 · see citing works
Implantable cardioverter defibrillators in people dying with cancer: A SEER‐Medicare analysis of ICD prevalence and association with aggressive end‐of‐life care
Mullins, M. A., Wang, T., Shahan, K. L., Zaha, V. G., Goswami, R., Sulistio, M. S., Gerber, D. E., & Pruitt, S. L. (2024) · Cancer · doi:10.1002/cncr.35640 · Cited by 1 · see citing works
Factors and Considerations in No‐Treatment Decisions in Patients With Key Hematological Malignancies: A Nationwide, Population‐Based Study in the Netherlands
Zijlstra, M., Snijders, R. A. H., de Boer, F., Chamuleau, M. E. D., Fransen, H. P., Oerlemans, S., van der Padt‐Pruijsten, A., Posthuma, E. F. M., Visser, O. J., Zweegman, S., et al. (2025) · European Journal Of Haematology · doi:10.1111/ejh.14390 · Cited by 1 · see citing works
Patients' Experiences With Advance Care Planning and Decision‐Making: An Interview Study in Finnish Hospital Palliative Care Wards
Kuusisto, A. M., Saranto, K., Lähteenmäki, K., Soikkeli‐Jalonen, A., & Haavisto, E. (2025) · Nursing Open · doi:10.1002/nop2.70158 · Cited by 1 · see citing works
Advanced Care Planning Conversations: A Scoping Review of Nurse Practitioners’ Approach
Hussein, M. T. E., & Favell, D. (2025) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2025.105421 · Cited by 1 · see citing works
Casemanagers Positioned as Key Advance Care Planning Conversationalists in Oncology Care: A Qualitative Interview Study on the Perspectives of Healthcare Professionals and Patients
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Authors: Starr, L. T., Ulrich, C. M., Corey, K. L., & Meghani, S. H.
Affiliations: Leonard Davis Institute of Health Economics (US)
University of Pennsylvania (US)
Corresponding author: Starr, Lauren T.
ORCID: Starr, Lauren T.
Ulrich, Connie M.
Meghani, Salimah H.
Venue: American Journal of Hospice and Palliative Medicine®
Publisher: SAGE Publications
Published: 2019-05-09
Volume: 36
Issue: 10
Pages: 913-926
ISSN: 1049-9091 (ISSN-L)
1938-2715
DOI: 10.1177/1049909119848148
PMC: PMC6711813
OpenAlex: W2944707386
Cited by: 132
References: 54
Citations by year: 2026: 13 · 2025: 22 · 2024: 26 · 2023: 22 · 2022: 23 · 2021: 12 · 2020: 14
FWCI: 2.00
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: American Journal of Hospice and Palliative Medicine® (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Leonard Davis Institute of Health Economics at the University of Pennsylvania (Jonas Nurse Leaders Scholars program)
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 › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: end-of-life discussions, advance care planning, goals of care discussions, advanced cancer, health care utilization, end-of-life care costs, place of death, hospice use, chemotherapy near death, quality of end-of-life care
MeSH terms: Communication, Health Expenditures, Health Resources, Health Services, Humans, Neoplasms, Patient Acceptance of Health Care, Patient Care Planning, Quality of Life, Severity of Illness Index, Terminal Care, Advance Care Planning

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Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review

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