2018 ASCO Annual Meeting!
Session: Patient and Survivor Care
Type: Poster Session
Time: Monday June 4, 1:15 PM to 4:45 PM
Location: Hall A
Aligning goals of care with aggressiveness at end of life (EOL).
Patient and Survivor Care
2018 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #14)
J Clin Oncol 36, 2018 (suppl; abstr 10026)
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: Aggressiveness of care at EOL should be aligned with the patient’s (Pt) goals of care that ideally are established in collaboration with the oncologist (MD). This is particularly important for Pts with advanced disease. Methods: A longitudinal study was conducted. 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 using a visual analog scale (VAS). Scores on the VAS ranged from 0 (comfort, quality of life) to 100 (survival, length of life). Individual scores > = 70 indicated a strong preference for prolonging survival and presumably a willingness to undergo aggressive interventions. Scores < = 30 indicated a strong preference for comfort care and presumably a willingness to forgo aggressive interventions. Aggressiveness of care was assessed using standard indicators (e.g. > 1 hospitalization in last 30 days of life, hospice stay < 3 days, etc.). 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). As seen in Table 1, when there was strong agreement between Pt and MD on goals (either survival or comfort) the patient received levels of aggressiveness of care that were reflective of the goals. For example, when Pt and MD agreed on the goal of survival, 90% received at least 1 indicator of aggressive treatment. Conclusions: These data confirm the importance of aligning Pt and MD goals of care. When there are differences in goals, regardless of whether the Pt or MD identified comfort as the priority, Pts are at risk for receiving care that is not congruent with their preferences and goals of care.
Pt > MD
MD > Pt
Pt > MD
MD > Pt
|% of Subjects (n = 168)||17.3%||11.3%||5.95%||19.6%||23.8%||12.5%|
|Hospice LOS: Md||12.5||15||2||12||13||20.5|
|No Aggressive Tx (%)||75%||63%||10%||66%||64%||81%|