Medline ® Abstracts for References 2,3
of 'Discussing goals of care'
End-of-life care preferences and needs: perceptions of patients with chronic kidney disease.
Clin J Am Soc Nephrol. 2010;5(2):195. Epub 2010 Jan 14.
BACKGROUND AND OBJECTIVES: Despite high mortality rates, surprisingly little research has been done to study chronic kidney disease (CKD) patients' preferences for end-of-life care. The objective of this study was to evaluate end-of-life care preferences of CKD patients to help identify gaps between current end-of-life care practice and patients' preferences and to help prioritize and guide future innovation in end-of-life care policy.
DESIGN, SETTING, PARTICIPANTS,&MEASUREMENTS: A total of 584 stage 4 and stage 5 CKD patients were surveyed as they presented to dialysis, transplantation, or predialysis clinics in a Canadian, university-based renal program between January and April 2008.
RESULTS: Participants reported relying on the nephrology staff for extensive end-of- life care needs not currently systematically integrated into their renal care, such as pain and symptom management, advance care planning, and psychosocial and spiritual support. Participants also had poor self-reported knowledge of palliative care options and of their illness trajectory. A total of 61% of patients regretted their decision to start dialysis. More patients wanted todie at home (36.1%) or in an inpatient hospice (28.8%) compared with in a hospital (27.4%). Less than 10% of patients reported having had a discussion about end-of-life care issues with their nephrologist in the past 12 months.
CONCLUSIONS: Current end-of-life clinical practices do not meet the needs of patients with advanced CKD.
Department of Medicine, University of Alberta, Alberta, Canada. email@example.com
Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study.
Mack JW, Cronin A, Keating NL, Taback N, Huskamp HA, Malin JL, Earle CC, Weeks JC
J Clin Oncol. 2012;30(35):4387.
PURPOSE: National guidelines recommend that discussions about end-of-life (EOL) care planning happen early for patients with incurable cancer. We do not know whether earlier EOL discussions lead to less aggressive care near death. We sought to evaluate the extent to which EOL discussion characteristics, such as timing, involved providers, and location, are associated with the aggressiveness of care received near death.
PATIENTS AND METHODS: We studied 1,231 patients with stage IV lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system-based prospective cohort study, who died during the 15-month study period but survived at least 1 month. Our main outcome measure was the aggressiveness of EOL care received.
RESULTS: Nearly half of patients received at least one marker of aggressive EOL care, including chemotherapy in the last 14 days of life (16%), intensive care unit care in the last 30 days of life (9%), and acute hospital-based care in the last 30 days of life (40%). Patients who had EOL discussions with their physicians before the last 30 days of life were less likely to receive aggressive measures at EOL, including chemotherapy (P = .003), acute care (P<.001), or any aggressive care (P<.001). Such patients were also more likely to receive hospice care (P<.001) and to have hospice initiated earlier (P<.001).
CONCLUSION: Early EOL discussions are prospectively associated with less aggressive care and greater use of hospice at EOL.
Dana-Farber Cancer Institute, Boston, MA 02215, USA. firstname.lastname@example.org