|
|
|
|
|
|
|
|
|
|
Abstract
- •
- Discussion of end-of-life care occurred late in the disease process and during hospital admissions in ovarian cancer patients.
- •
- Earlier end-of-life discussions are associated with better quality of cancer care.
Objectives
(1)
To describe the prevalence, timing and setting of documented
end-of-life (EOL) discussions in patients with advanced ovarian cancer;
and (2) To assess the impact of timing and setting of documented
end-of-life discussions on EOL quality care measures.
Methods
Retrospective
study of women who died of ovarian cancer diagnosed between 1999-2008.
EOL quality measures assessed: chemotherapy in the last 14 days of life,
> 1 hospitalization in the last 30 days, > 1 ER visit in the last
30 days, intensive care unit (ICU) admission in the last 30 days, dying
in an acute care setting, admitted to hospice ≤ 3 days.
Results
One
hundred seventy-seven (80%) patients had documented end-of-life
discussions. Median interval from EOL discussion until death was 29
days. Seventy-eight patients (44%) had EOL discussions as outpatient and
99 (56%) as inpatient. Sixty-four out of 220 (29%) patients’ care did
not conform to at least one EOL quality measure. An EOL discussion at
least 30 days before death was associated with a lower incidence of:
chemotherapy in the last 14 days of life (p=0.003), > 1
hospitalization in the last 30 days (p<0.001), ICU admission in the
last 30 days (p=0.005), dying in acute care setting (p=0.01), admitted
to hospice ≤ 3 days (p=0.02). EOL discussion as outpatient was
associated with fewer patients hospitalized > 1 in the last 30 days
of life (p<0.001).
Conclusions
End-of-life
care discussions are occurring too late in the disease process.
Conformance with EOL quality measures can be achieved with earlier
end-of-life care discussions.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.