Timing of end-of-life care discussion with performance on end-of-life quality indicators in ovarian cancer

• Published in: Gynecologic oncology Vol. 130; no. 1; pp. 156 - 161
• Main Authors: Lopez-Acevedo, Micael, Havrilesky, Laura J, Broadwater, Gloria, Kamal, Arif H, Abernethy, Amy P, Berchuck, Andrew, Alvarez Secord, Angeles, Tulsky, James A, Valea, Fidel, Lee, Paula S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2013
• Subjects: Adult; Aged; Aged, 80 and over; Aggressiveness of care; End-of-life; Fallopian Tube Neoplasms - drug therapy; Fallopian Tube Neoplasms - psychology; Female; Health care resource utilization; Health Resources; Hematology, Oncology and Palliative Medicine; Hospice care; Humans; Middle Aged; Obstetrics and Gynecology; Ovarian cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - psychology; Peritoneal Neoplasms - drug therapy; Peritoneal Neoplasms - psychology; Quality metrics; Quality of Life; Retrospective Studies; Terminal Care - methods; Terminal Care - standards; Time Factors; End-of-life; Aggressiveness of care; Quality metrics; Hospice care; Ovarian cancer; Health care resource utilization
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2013.04.010

Abstract Objectives (1) To describe the prevalence, timing and setting of documented end-of-life (EOL) discussions in patients with advanced ovarian cancer; and (2) to assess the impact of timing and setting of documented end-of-life discussions on EOL quality care measures. Methods A retrospective study of women who died of ovarian cancer diagnosed between 1999 and 2008 was conducted. The following are the EOL quality measures assessed: chemotherapy in the last 14 days of life, > 1 hospitalization in the last 30 days, > 1 ER visit in the last 30 days, intensive care unit (ICU) admission in the last 30 days, dying in an acute care setting, admitted to hospice ≤ 3 days. Results One hundred seventy-seven (80%) patients had documented end-of-life discussions. Median interval from EOL discussion until death was 29 days. Seventy-eight patients (44%) had EOL discussions as outpatient and 99 (56%) as inpatient. Sixty-four out of 220 (29%) patients' care did not conform to at least one EOL quality measure. An EOL discussion at least 30 days before death was associated with a lower incidence of: chemotherapy in the last 14 days of life ( p = 0.003), > 1 hospitalization in the last 30 days ( p < 0.001), ICU admission in the last 30 days ( p = 0.005), dying in acute care setting ( p = 0.01), admitted to hospice ≤ 3 days ( p = 0.02). EOL discussion as outpatient was associated with fewer patients hospitalized > 1 in the last 30 days of life ( p < 0.001). Conclusions End-of-life care discussions are occurring too late in the disease process. Conformance with EOL quality measures can be achieved with earlier end-of-life care discussions.