Associations of Early Completion of Advance Directives With Key End-of-Life Quality Measures: Analysis of an ASCO Quality Oncology Practice Initiative Patient Cohort

Abstract

PURPOSE: Despite the growing calls for early and ubiquitous completion of advance directives (ADs), studies exploring links between AD completion and their impact on outcomes of patients with cancer have mixed conclusions. We used the ASCO Quality Oncology Practice Initiative (QOPI) registry to compare end-of-life (EOL) quality measures and the effect of QOPI certification among patients with and without early AD completion, defined as completion within the first three oncology visits after cancer diagnosis. METHODS: Deidentified patient-level data were analyzed from the QOPI database from 2015 through 2017. Associations were assessed using Chi-square tests between early AD completion and patient enrollment in hospice < 7 days before death, chemotherapy receipt in the last 14 days of life, or with emergency room visits or intensive care unit admissions in the last 30 days of life. RESULTS: Data from 31,558 patients eligible for the AD question were analyzed. Patients treated at QOPI-certified practices had higher rates of early AD completion than patients at non-certified practices. Early AD completion was not associated with differences in hospice enrollment for < 7 days before death, chemotherapy receipt in the last 14 days of life, or emergency room visits or intensive care unit encounters in the last 30 days of life. CONCLUSION: The study found that QOPI certification is associated with higher rates of early AD completion. However, early AD completion was not associated with recognized EOL quality measures. Future research should focus on the timing, frequency, and content of AD conversations to demonstrate the impact on care at the EOL.

Impacto das diretivas antecipadas de vontade na qualidade de morte de pacientes em cuidados paliativos: revisão integrativa

“…Verificou-se que a presença de DAV também foi associado ao tipo de patologia (STEINER et al, 2018). Câncer seguido de doenças neurodegenerativas e cardiopatias foram as doenças predominantes para recebimento de cuidados paliativos e realização da DAV (CHEUNG et al, 2018;DENIS et al, 2020;HU et al, 2021;KELLY et al, 2019;MARCHI et al, 2021;NAASAN et al, 2022;OKUMURA;SAWAMURA;MUROHARA, 2018;POWER et al, 2023;STEINER et al, 2018). Isso porque, o emprego da prática de cuidados paliativos nos diagnósticos citados tem sido mais difundido e estudado (HALPERN et al, 2020;MCDERMOTT et al, 2020).…”

“…Deste total, 11 estudos confirmaram os efeitos positivos da DAV na qualidade de morte e na diminuição de intensidade de procedimentos hospitalares em fim-de-vida. Um estudo, dePOWER et al, 2023, não demonstrou evidências estatisticamente significativas da melhoria dos cuidados de fim de vida mediante a realização precoce da DAV. a outras patologias, tais como câncer de pulmão e insuficiência cardíaca(STEINER et al, 2018).…”