Goals of care documentation by medical oncologists and oncology patient end-of-life care outcomes Journal Article
| Authors: | Epstein, A. S.; Riley, M.; Nelson, J. E.; Bernal, C.; Martin, S.; Xiao, H. |
| Article Title: | Goals of care documentation by medical oncologists and oncology patient end-of-life care outcomes |
| Abstract: | Background: Goals of care (GOC) documentation is important but underused. We aimed to improve oncologist GOC documentation and end-of-life (EOL) care. Methods: In April 2020, our cancer center launched a GOC note template, including optional fields for documenting discussion with the patient about: cancer natural history, goals, and/or EOL (resuscitation preferences, hospice receptivity). Associations between GOC notes and EOL care were evaluated. Results: Among 1721 patients dying between June 1, 2020 and June 30, 2021, median days from first GOC note (± with documentation of EOL discussion) to death was 92, whereas a GOC note including EOL discussion (“GOC EOL note”), specifically, was 31. Patients with a first GOC note >60 days before death spent fewer days inpatient (6.7 vs 10.6 days, p <.001). Among patients with GOC EOL notes, those with such documentation >30 days before death had fewer inpatient (5 vs 11, p <.001) and intensive care unit days (0.5 vs 1.5, p <.001), more hospice referrals (57% vs 44%, p =.003), and less chemotherapy ≤14 days before death (6% vs 11%, p =.010). Of 925 admissions of patients dying within ≤30 days, those with GOC EOL notes were shorter (7 vs 9 days, p =.013) but not associated with more hospice discharge (30% vs 25%, p =.163). Oncologist (vs nononcologist) GOC documentation and earlier documentation of EOL discussion were associated in subset analyses with less inpatient care and more hospice referrals. Conclusions: Documentation of GOC, including EOL discussions, is associated with favorable performance on accepted indicators of quality EOL care. © 2022 American Cancer Society. |
| Keywords: | adult; cancer chemotherapy; controlled study; medical oncologist; major clinical study; cancer patient; outcome assessment; neoplasm; neoplasms; history; cancer center; intensive care unit; communication; hospital patient; terminal care; end-of-life care; hospice; patient care planning; resuscitation; hospice care; documentation; oncologist; oncologists; advance care planning; cancer; humans; human; male; female; article; goals of care |
| Journal Title: | Cancer |
| Volume: | 128 |
| Issue: | 18 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 2022-09-15 |
| Start Page: | 3400 |
| End Page: | 3407 |
| Language: | English |
| DOI: | 10.1002/cncr.34400 |
| PUBMED: | 35866716 |
| PROVIDER: | scopus |
| PMCID: | PMC9420787 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
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