10 Jul Many Cancer Patients Never Communicate Their Preferences For End of Life Care
Medical Research: What is the background for this study? What are the main findings?
Dr. Narang: The care provided to cancer patients at end-of-life can be intense, including frequent ER visit, hospitalizations, and ICU stays in the last month of life, administration of chemotherapy in last two weeks of life, and late referrals to hospice. Providing high-intensity treatments at end-of-life has been associated with reduced patient quality-of-life and increased caregiver bereavement. Advance care planning represents an opportunity for patients to indicate their preferences for end-of-life care to try to ensure that the care that they receive at end-of-life is consistent with their values, and has been endorsed by oncologic professional societies, such as ASCO and the NCCN. As such, we wanted to assess if oncologists’ long-standing recognition of the merits of advance care planning has translated into increased participation in advance care planning by cancer patients, and to determine which forms of advance care planning are associated with intensity of care given at end-of-life.
From 2000-12, we found that the only type of advance care planning that increased was the assignment of a power of attorney (52% in 2000 to 74% in 2012). However, having a power of attorney was not associated with receiving less aggressive end-of-life care. On the other hand, having a living wills and engaging in a discussion with a provider or loved one about preferences for end-of-life care were both associated with reduced treatment intensity. However, the frequency with which cancer patients created a living or discussed their preferences for end-of-life care did not increase over the study period; importantly, 40% of patients dying of cancer never communicated their preferences for care at end-of-life with anyone.
Medical Research: What should clinicians and patients take away from your report?
Dr. Narang: Overall, it appears that many cancer patients never communicate their preferences for end-of-life care prior to death. Moreover, assignment of a durable power of attorney, without communication of values and preferences for end-of-life care, is likely an ineffective form of advance care planning, as patients’ loved ones may default to providing all care possible.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Narang: Efforts to bolster discussions between clinicians and patients regarding preferences for end-of-life are critical. This may be achieved by expanding opportunities for training in palliative care and increasing the number of palliative care clinics. Pioneering health systems that have been successful in increasing participation in advance care planning amongst their population may also provide successful strategies to emulate. Importantly, all of these initiatives must include patients’ caregivers and loved ones, who ultimately may be responsible for dictating the care provided at end-of-life.
Amol Narang MD (2015). Many Cancer Patients Never Communicate Their Preferences For End of Life Care