2018 ASCO Annual Meeting!
Session: Patient and Survivor Care
Type: Oral Abstract Session
Time: Sunday June 3, 8:00 AM to 11:00 AM
Patient (Pt) and oncologist (MD) discordance in goals of care in end of life (EOL) decision making.
Patient and Survivor Care
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr 10007)
Author(s): Sara L Douglas, Barbara J Daly, Neal J. Meropol, Amy R Lipson; Case Western Reserve University-Nursing and Case Comprehensive Cancer Center, Cleveland, OH; Flatiron Health, New York, NY; Case Western Reserve University-School of Nursing, Cleveland, OH
Background: Providing EOL care that is in accordance with Pt goals of care is an essential component of quality care. Because discordance between the attitudes of Pt and physician can undermine optimal EOL care, identification of disagreements regarding goals of care is important, particularly in the context of advanced disease. Methods: This was a longitudinal design study. Adult Pts with Stage IV gastrointestinal (GI) or lung cancer were eligible. Each Pt and MD were surveyed at study enrollment and every 3 months for 15 months or until the Pt died. The primary variables of interest were the Pt and MD identified goals of care and what the MD believed to be the Pt’s goal of care, using a visual analog scale (VAS). Scores on the VAS ranged from 0 (comfort, quality of life) to 100 (survival, length of life). Discordance was defined as an absolute difference > 40 on the VAS. Results: Between January 2015 and July 2017, 378 Pts were enrolled. Refusal rate was 27.5%; attrition rate 8.1%. 168 Pts (44%) died and their results are presented. Mean age was 64 years (range = 36-88 years); 66% had GI and 34% had lung cancer. Mean time from enrollment to death was 6.5 months (range = 3 - 15 months). At the last assessment prior to Pt death, 32% of the Pt-MD pairs had discordant goals ( > 40 points different). In 60% of these cases, the Pt had more survival focused goals while in 40% of cases the MD had more survival focused goals. Also, 77% of Pt-MD pairs with discord at enrollment still had discord at the last assessment before death (p < .001). In comparing what the MD believed to be the Pt’s goal of care with the Pt’s actual goal of care at death, there was discord in 27% of the pairs. The correlation between MDs’ own identified goals for Pts and what MDs identified as the Pts’ goals was large (r= .71, p < .001). Conclusions: These data suggest that communication between Pts and MDs is suboptimal regarding goals of care at the EOL. Interventions to improve the explicit discussion of mutual goals of care over time between MDs and Pts are needed in order to ensure that patients receive EOL care consistent with their goals.