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 Mori
  • Donna Ellison
  • Takamaru Ashikaga
  • Ursula McVeigh
  • Allan Ramsay
  • Steven Ades
Original Article



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.


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).


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.


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


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


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Masanori Mori
    • 1
  • Donna Ellison
    • 2
  • Takamaru Ashikaga
    • 3
  • Ursula McVeigh
    • 4
  • Allan Ramsay
    • 4
  • Steven Ades
    • 5
  1. 1.Department of Palliative MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
  2. 2.Office of Clinical Trials ResearchUniversity of Vermont College of MedicineBurlingtonUSA
  3. 3.Department of Medical BiostatisticsUniversity of Vermont College of MedicineBurlingtonUSA
  4. 4.Department of Family Practice, Palliative MedicineFletcher Allen Health Care/University of Vermont College of MedicineBurlingtonUSA
  5. 5.Division of Hematology and OncologyFletcher Allen Health Care/University of Vermont College of MedicineBurlingtonUSA

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