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End-of-Life Care Discussions Among Patients With Advanced Cancer: A Cohort Study
Open accessAbstract
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 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 [15]
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Mosher, C. E., Beck‐Coon, K., Wu, W., Lewson, A. B., Stutz, P. V., Brown, L. F., Tang, Q., Helft, P. R., Levoy, K. N., Hickman, S. E., et al. (2024) · Figshare · doi:10.6084/m9.figshare.27129627
Paladino, J., Sanders, J. J., Fromme, E. K., Block, S. D., Jacobsen, J. C., Jackson, V. A., Ritchie, C. S., & Mitchell, S. E. (2024) · Figshare · doi:10.6084/m9.figshare.26605969
Metadata
- 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)
- 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
- 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
- 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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