Cited by 420Palliative Care and End-of-Life IssuesPalliative and Oncologic CarePatient-Provider Communication in Healthcare

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End-of-Life Care Discussions Among Patients With Advanced Cancer: A Cohort Study

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Mack, Jennifer W., Cronin, Angel, Taback, Nathan, Huskamp, Haiden A., Keating, Nancy L., Malin, Jennifer L., Earle, Craig C., Weeks, Jane C.·2012·Annals of Internal Medicine

DOI 10.7326/0003-4819-156-3-201202070-00008PMC PMC3616320

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Abstract

BACKGROUND: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year. OBJECTIVE: To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these discussions take place. DESIGN: Prospective cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005. SETTING: Participants lived in Northern California, Los Angeles County, North Carolina, Iowa, or Alabama or received care in 1 of 5 large HMOs or 1 of 15 Veterans Health Administration sites. PATIENTS: 2155 patients with stage IV lung or colorectal cancer. MEASUREMENTS: End-of-life care discussions reported in patient and surrogate interviews or documented in medical records through 15 months after diagnosis. RESULTS: 73% of patients had EOL care discussions identified by at least 1 source. Among the 1470 patients who died during follow-up, 87% had EOL care discussions, compared with 41% of the 685 patients who were alive at the end of follow-up. Of the 1081 first EOL care discussions documented in records, 55% occurred in the hospital. Oncologists documented EOL care discussions with only 27% of their patients. Among 959 patients with documented EOL care discussions who died during follow-up, discussions took place a median of 33 days before death. LIMITATIONS: The depth and quality of EOL care discussions was not evaluated. Much of the information about discussions came from surrogates of patients who died before baseline interviews could be obtained. CONCLUSION: Although most patients with stage IV lung or colorectal cancer discuss EOL care planning with physicians before death, many discussions occur during acute hospital care, with providers other than oncologists, and late in the course of illness. PRIMARY FUNDING SOURCE: National Cancer Institute and Department of Veterans Affairs.

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“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].”
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Authors: Mack, J. W., Cronin, A., Taback, N., Huskamp, H. A., Keating, N. L., Malin, J. L., Earle, C. C., & Weeks, J. C.
Affiliations: Ontario Institute for Cancer Research (CA)
ORCID: Mack, Jennifer W.
Cronin, Angel
Taback, Nathan
Huskamp, Haiden A.
Keating, Nancy L.
Earle, Craig C.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2012-02-07
Volume: 156
Issue: 3
Pages: 204-210
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-156-3-201202070-00008
PMC: PMC3616320
OpenAlex: W2028440176
Cited by: 420
References: 31
Citations by year: 2026: 18 · 2025: 25 · 2024: 27 · 2023: 32 · 2022: 29 · 2021: 29 · 2020: 36 · 2019: 37 · 2018: 26 · 2017: 28 · 2016: 28 · 2015: 29 · 2014: 30 · 2013: 31 · 2012: 13
FWCI: 31.81
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5u01ca093344-08)
National Cancer Institute (U01CA093339, U01CA093326, U01-CA093344, U01CA093348, U01CA093329, K05CA166208, U01CA093332, U01CA093324)
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, stage IV lung cancer, stage IV colorectal cancer, oncologists, surrogate decision makers, timing of discussions, hospital care, health maintenance organizations
MeSH terms: Adult, Aged, Aged, 80 and over, Communication, Female, Humans, Lung Neoplasms, Male, Medical Oncology, Middle Aged, Palliative Care, Patient Care Planning, Physician-Patient Relations, Terminal Care, Time Factors, Colorectal Neoplasms, Practice Guidelines as Topic, Young Adult

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End-of-Life Care Discussions Among Patients With Advanced Cancer: A Cohort Study

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