Original Article

Supportive Care in Cancer

, Volume 21, Issue 2, pp 629-636

In-advance end-of-life discussions and the quality of inpatient end-of-life care: a pilot study in bereaved primary caregivers of advanced cancer patients

  • Masanori MoriAffiliated withDepartment of Palliative Medicine, Seirei Hamamatsu General Hospital Email author 
  • , Donna EllisonAffiliated withOffice of Clinical Trials Research, University of Vermont College of Medicine
  • , Takamaru AshikagaAffiliated withDepartment of Medical Biostatistics, University of Vermont College of Medicine
  • , Ursula McVeighAffiliated withDepartment of Family Practice, Palliative Medicine, Fletcher Allen Health Care/University of Vermont College of Medicine
  • , Allan RamsayAffiliated withDepartment of Family Practice, Palliative Medicine, Fletcher Allen Health Care/University of Vermont College of Medicine
  • , Steven AdesAffiliated withDivision of Hematology and Oncology, Fletcher Allen Health Care/University of Vermont College of Medicine

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Abstract

Purpose

Advanced cancer care planning is encouraged to achieve individualized care. We hypothesized that in-advance end-of-life (EOL) discussions and establishment of do-not-resuscitate (DNR) status prior to the terminal admission would be associated with better quality of inpatient EOL care.

Methods

We conducted a post-mortality survey, utilizing the validated Toolkit of Instruments to Measure End-of-Life Care. Primary caregivers (PCGs) of the advanced cancer patients who died at our institution between January 2009 and December 2010 were contacted more than 3 months after the patients’ death. The endpoints included overall score for EOL care (0–10; 10 = best care), problem scores of six domains (0–1; 1 = worst problem), and score for supporting family’s self-efficacy (knowing what to expect/do during the dying process) (1–3; 3 = greatest support).

Results

Of 115 PCGs contacted, 50 agreed to participate (43.5 %). Patients with EOL discussions (n = 20), as compared to those without (n = 29), had higher rating of overall EOL care (9.7 vs. 8.7; p = 0.001): lower problem scores in “informing and promoting shared decision-making” (0.121 vs. 0.239; p = 0.007), “encouraging advanced care planning” (0.033 vs. 0.167; p = 0.010), “focusing on individual” (0.051 vs. 0.186; p = 0.014), “attending to emotional/spiritual needs of family” (0.117 vs. 0.333; p = 0.010), and “providing care coordination” (0.100 vs. 0.198; p = 0.032), and greater support for family’s self-efficacy (2.734 vs. 2.310; p < 0.001). No significant differences were found in these outcomes between patients with DNR (n = 19) and those with full code (n = 31) on admission.

Conclusion

Advanced cancer patients may receive higher quality of inpatient EOL care if they had in-advance EOL discussions.

Keywords

Advanced cancer End-of-life discussions Code status Do-not-resuscitate (DNR) Quality of inpatient end-of-life care Primary caregivers