Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study

Mack, Jennifer W.; Cronin, Angel M.; Keating, Nancy L.; Taback, Nathan; Huskamp, Haiden A.; Malin, Jennifer L.; Earle, Craig C.; Weeks, Jane C.

doi:10.1200/jco.2012.43.6055

Cited by 477 publications

(379 citation statements)

References 31 publications

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“…In the "Coping with Cancer" study, Wright et al showed that end-of-life discussion was signiicantly associated with a less aggressive medical care (such as ventilation, ICU admission, and resuscitation), a reduction in the bereaved caregiver's grief or depression, and a longer hospice stay [92]. Other similar studies also showed consistent results [1,93,94].…”

Section: Clinical Utility Of Prognostic Disclosuresupporting

confidence: 58%

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Uneno¹,

Kanai²

2017

Highlights on Several Underestimated Topics in Palliative Care

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Prognosis prediction is a clinically relevant issue to facilitate optimal decision-making for both physicians and patients with cancer. Many previous studies revealed that prognosis prediction based on the physician's intuition and/or clinical experience is inaccurate and often optimistic, which means that there is a tendency to overestimate patient survival in daily clinical practice. In recent decades, many eforts have been made to develop prognosis prediction models which aid physicians to make more accurate prognosis prediction. In this chapter, we review the representative prognosis prediction models in palliative care and related studies. In addition, we refer to several prognosis prediction models developed by unique methods (for instance, case-crossover design or machine learning). Finally, we focus on the possible clinical utility of prognosis prediction models. In fact, no previous studies have clearly demonstrated whether the application of such prognosis prediction models truly beneits patient care in daily clinical practice.Therefore, we will discuss how the application of prognosis prediction models could beneit patients under palliative care.

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Section: Clinical Utility Of Prognostic Disclosuresupporting

confidence: 58%

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Uneno¹,

Kanai²

2017

Highlights on Several Underestimated Topics in Palliative Care

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“…Being hesitant to stop futile palliative chemotherapy may lead to aggressive EOL care and life-sustaining treatment. Although discussion of EOL care has been shown to be associated with less aggressive EOL care [40], we still face difficult decisions about chemotherapy near the EOL among patients [13] and physicians. Physicians consistently overestimated prognosis by at least 30% [41]; their estimate of survival could be divided by 3.5 for actual survival [42].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Hsu

Chang

et al. 2016

The Oncologist

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Introduction. Although palliative chemotherapy during end‐of‐life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end‐of‐life care and less use of hospice service. This is a population‐based study of the association between palliative chemotherapy and aggressiveness of end‐of‐life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2–6 months before death were included. Aggressiveness of end‐of‐life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end‐of‐life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician's specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p < .001), more than one intensive care unit admission (p < .001), and endotracheal intubation (p = .02) during end‐of‐life care were significantly more common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p < .001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end‐of‐life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. Implications for Practice: Palliative chemotherapy is used for patients with incurable cancer toward the end of life (EOL). Aggressiveness of EOL care and hospice care are related to the quality of life of these patients. This study of data from the Taiwanese National Health Insurance Research Database found that palliative chemotherapy led to more aggressive EOL care and less hospice care. There is a need to provide patients with terminal cancer access to care information that best meets their needs, especially those patients who receive palliative chemotherapy.

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“…Although most patients were able to talk about their wishes for end-of-life care before death, the timing mattered; patients who had earlier discussions were less likely to receive aggressive measures at the end of life and more likely to receive hospice care. 44 Thus, physicians of patients facing death may do well to start discussing this possibility early rather than at a later moment of crisis.…”

Section: Addressing and Managing Prognostic Uncertaintymentioning

confidence: 99%

Communicating About Prognosis: Ethical Responsibilities of Pediatricians and Parents

2014

Self Cite

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Clinicians are sometimes reluctant to discuss prognosis with parents of children with life-threatening illness, usually because they worry about the emotional impact of this information. However, parents often want this prognostic information because it underpins informed decision-making, especially near the end of life. In addition, despite understandable clinician concerns about its emotional impact, prognostic disclosure can actually support hope and peace of mind among parents struggling to live with a child’s illness. Children, too, may need to understand what is ahead to manage uncertainty and make plans for the ways their remaining life will be lived. In this article, we describe the ethical issues involved in disclosure of prognostic information to parents and children with life-threatening illness and offer practical guidance for these conversations.

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Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study

Cited by 477 publications

References 31 publications

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Prognosis Prediction Models and their Clinical Utility in Palliative Care

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Communicating About Prognosis: Ethical Responsibilities of Pediatricians and Parents

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