Purpose: Conversations about personal values and goals of care (GOC) at the end of life are essential in caring for patients with advanced cancer. However, GOC conversations may be influenced by patient and oncologist factors during transitions of care.
Methods: We electronically administered surveys to medical oncologists of inpatients who died from May 1, 2020, to May 31, 2021. Primary outcomes included oncologists' knowledge of inpatient death, anticipation of patient death, and recollection of GOC discussions. Secondary outcomes, including GOC documentation and advance directives (ADs), were collected retrospectively from electronic health records. Outcomes were analyzed for association with patient, oncologist, and patient-oncologist relationship factors.
Results: For 75 patients who died, 104/158 (66%) surveys were completed by 40 inpatient and 64 outpatient oncologists. Eighty-one oncologists (77.9%) were aware of patients' deaths, 68 (65.4%) anticipated patients' deaths within 6 months, and 67 (64.4%) recalled having GOC discussions before or during the terminal hospitalization. Outpatient oncologists were more likely to report knowledge of patient death ( < .001), as were those with longer therapeutic relationships ( < .001). Inpatient oncologists were more likely to correctly anticipate patient death ( = .014). Secondary outcomes revealed 21.3% of patients had documented GOC discussions before admission and 33.3% had ADs; patients with a longer duration of cancer diagnosis were more likely to have ADs ( = .003). Oncologist-reported barriers to GOC included unrealistic expectations from patients or family (25%) and decreased patient participation because of clinical conditions (15%).
Conclusion: Most oncologists recalled having GOC discussions for patients with inpatient mortality, yet documentation of serious illness conversations remained suboptimal. Further studies are needed to examine barriers to GOC conversations and documentation during transitions of care and across health care settings.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538893 | PMC |
| http://dx.doi.org/10.1200/OP.23.00095 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Evolution in Documented Goals of Care at End of Life for Adolescents and Younger Adults With Cancer.
JAMA Netw Open
December 2024
Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
Importance: Little is known about the nature of change in goals of care (GOC) over time among adolescents and younger adult (AYA) patients aged 12 to 39 years with cancer near the end of life. Understanding how GOC evolve may guide clinicians in supporting AYA patients in making end-of-life decisions.
Objective: To assess frequency, timing, and evolution of documented GOC among AYA patients with cancer in the last 90 days of life.
Implementing Goals of Care Notes in a Statewide Health System: A Quality Improvement Initiative.
Am J Med
December 2024
IUH Department of Palliative Care, Indiana University Health, Indianapolis, IN; Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Ageing Research, Regenstreif Institute, Indianapolis, IN.
Background: Goals of care (GOC) documentation for seriously ill patients is integral to patient-centered care but not standardized. Collaborative efforts within the health system to improve the frequency and documentation of GOC to communicate patient preferences and values are essential to ensure both quality of life and quality of death.
Measures: We created a standard GOC note type and location in the electronic medical record for a large, statewide health system in the Midwest.
Medical Communication Training: The Effect of Gender and Experience and Goals of Care Discussions.
South Med J
December 2024
Internal Medicine and Section of Supportive and Palliative Care, University of Texas Southwestern Medical Center, Dallas.
Objectives: Communication skills are increasingly recognized as a crucial component of medical training; however, little is known about the efficacy of various training methods when considering diverse student backgrounds, such as gender and prior training experience (ie, year of residency). This study explores medical learners' perceptions of effective communication in conducting goals of care (GOC) discussions with patients after receiving communication training as well as assessing for differences in preparedness for GOC discussions by gender and prior training experience.
Methods: This study included a sample of 114 residents in either their first, second, or third year of Internal Medicine residency.
End-of-Life Care in Hematology/Oncology Fellowship.
J Palliat Med
November 2024
Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
Article Synopsis
- Aggressive end-of-life (EOL) care for cancer patients often results in more hospitalizations and a poorer quality of death, while effective goals of care (GOC) discussions can lead to fewer hospitalizations and increased hospice use.* -
- A study at an academic cancer center found that less than half of patients had documented GOC discussions, despite those discussions being linked to higher rates of hospice enrollment and lower hospitalizations.* -
- It’s suggested that hematology-oncology fellowship programs should enhance communication skills training to improve the quality of GOC documentation and EOL care for patients.*
Spectrum of Clinical and Imaging Features of Children With GFAP Astrocytopathy.
Neurol Neuroimmunol Neuroinflamm
January 2025
From the Departments of Pediatric Neurology (S.S., A.B., K.R.), and Pediatric Radiology (A.P., R.C.), Children's Hospital Datteln, Witten/Herdecke University, Datteln, Germany; Consultant Child Neurologist and Epileptologist at Neoclinic Children's Hospital (V.J.), Jaipur, India; Department of Pediatric Neurology (T.K.), Children's Hospital Datteln, University Witten/Herdecke; Faculty of Health (T.K.), Department of Psychology and Psychotherapy, Chair of Personality Psychology and Diagnosis, Witten/Herdecke University; Center for Paediatric and Adolescent Medicine (U.D.), University Medical Clinic, Mainz; University Children's Hospital Regensburg (KUNO) (T.G.), Hospital St. Hedwig of the Order of St. John, University of Regensburg; Department of Pediatric Neurology (A.N.), VAMED Klinik Geesthacht; Department of Pediatrics (A.N.), University Medical Center Hamburg-Eppendorf; Department of Pediatric Neurology (C.L.-N.), Mutterhaus der Borromäerinnen, Trier; Department of Pediatric Intensive Care (R.A.-H.), University Children's Hal Marburg; Department of Pediatric Neurology (M.F.-B.), Saarland University Medical Center, Homburg/Saar, Germany; Assistance Publique-Hôpitaux de Paris (K.D.), Paris-Saclay University Hospitals, Bicêtre Hospital, Pediatric Neurology Department, National Referral Center for Rare Inflammatory and Auto-immune Brain and Spinal Diseases, Paris Saclay University, France; Neuroimmunology Unit (T.A.), in Sant Joan de Déu Children's Hospital, Esplugues de Llobregat, Barcelona; Neuroimmunology Program (T.A., G.O.-C.), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell, Sabadell, Barcelona, Spain; Neuroimmunology Laboratory (S.K.), Amrita Institute of Medical Sciences, School of Medicine, Amrita University, Kochi, India; Department of Pediatrics (A.K.); Center for Rare Diseases (A.K.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany; Department of Pediatric Neurology (H.M.); Pediatric Neurology Institute (A.F.-V.), Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Institute of Pediatric Neurology (E.G.-C.), Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; University Children's Hospital Oldenburg (H.L.), Department of Neuropediatrics, Oldenburg; Neuropediatric Unit (A.H., R.W.), Karolinska University Hospital and Karolinska Institute Stockholm, Sweden; and Institute of Clinical Chemistry (J.D., F.L.), Neuroimmunology Unit and Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany.
Article Synopsis
- This study investigates the clinical and MRI characteristics of children with autoimmune GFAP astrocytopathy, revealing limited data compared to what is known in adults.
- Researchers analyzed cases of 15 children from various clinical centers, finding common symptoms like acute encephalitis and meningitis, and specific MRI patterns in all cases.
- The findings suggest that GFAP antibodies lead to distinct clinical and imaging features, emphasizing the need for testing in pediatric patients with similar symptoms, especially those with brainstem involvement.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!