End-of-Life Care Discussions among Patients with Advanced Cancer

National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year.

Annals of Internal Medicine, Feb 2012 issue reports the results of a cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005 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.

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 involving patients: 2155 patients with stage IV lung or colorectal cancer.

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The study finds: •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.

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.

This is one of the many important aspects we look at when we take care of a patient who is nearing the end of his/her life. It’s often not pleasant to ask such questions.

But this is an important subject for the patient and the family which should not be over-looked. We, at BrightStar, never shy away from doing a difficult job.

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