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Sub-category:
Outcomes Research
Category:
Health Services Research
Meeting:
2008 ASCO Annual Meeting
Session Type and Session Title:
Oral Presentation, Health Services Research
Abstract No:
6505
Citation:
J Clin Oncol 26: 2008 (May 20 suppl; abstr 6505)
Author(s):
A. A. Wright, A. Ray, B. Zhang, J. W. Mack, S. L. Mitchell, M. E. Nilsson, E. T. Trice, S. D. Block, P. K. Maciejewski, H. G. Prigerson
Abstract:
Background: Physicians are concerned that end-of-life (EOL) discussions may distress terminally ill patients, and may not offer benefit. Little is known, however, about whether EOL discussions are associated with psychological distress and medical care received at the EOL. Methods: Coping with Cancer (CwC) is an NCI/NIMH-funded, prospective, longitudinal, multi-institutional study of 603 advanced cancer patients. Patients were interviewed on enrollment and followed until death; medical care received in the last week of life was obtained from chart review. Patients who reported having had EOL conversations were compared with those who did not on their degree of emotional distress [e.g. severity of psychological symptoms such as worry and rates of Major Depressive Disorder (MDD) using the Structured Clinical Interview for DSM-IV], terminal illness acknowledgement, treatment preferences, and medical care. Results: 188 of 603 patients (31.2%) reported EOL discussions with physicians. No mental health differences were found. Patients reporting EOL discussions were not more likely to meet criteria for MDD [rates were 7.2% vs. 7.4%, odds ratio (OR)=0.98, 95% confidence interval (CI) 0.50-1.90] or feel "nervous or worried" [adjusted least mean squares 2.81 vs. 2.77, t=-0.16, p=0.87]. They were more likely to acknowledge being terminally ill [adjusted OR (AOR)=2.24, CI 1.45-3.44], value comfort care over life extension (AOR=3.23, CI 2.02-5.17), and complete a DNR order (AOR= 3.62, CI 2.36-5.56). Among the 323 CwC decedents, patients reporting EOL conversations were less likely to undergo ventilation (AOR= 0.04, CI 0.004-0.43) or ICU admission (AOR= 0.21, CI 0.05-0.88), and more likely to receive hospice (AOR=2.13, CI 1.13-4.02). After propensity score matching, lower rates of ICU admission (AOR 0.21, CI 0.05-0.88) and ventilation (AOR 0.11, CI 0.01-0.87) remained. Conclusions: EOL care discussions between physicians and patients with advanced cancer are not associated with psychological distress. Furthermore, these discussions may result in increased patient understanding of illness severity, fewer invasive procedures, and lower rates of ICU admission at the EOL.
Abstract Disclosures
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy
and are designated with a caret symbol (^) here and in the print version.
 Associated Presentation(s):
Other Abstracts in this Sub-Category:
Abstracts by A. A. Wright :
Presentations by A. A. Wright :
Educational Book Manuscripts by A. A. Wright :
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