Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

Sangeeta C. Ahluwalia, Diana M. Tisnado, Anne M. Walling, Sydney E Dy, Steven M. Asch, Susan L. Ettner, Benjamin Kim, Philip Pantoja, Hannah C. Schreibeis-Baum, Karl A. Lorenz

Research output: Contribution to journalArticle

Abstract

Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care.

Original languageEnglish (US)
Pages (from-to)834-841
Number of pages8
JournalJournal of Palliative Medicine
Volume18
Issue number10
DOIs
StatePublished - Oct 1 2015

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Patient Care Planning
Terminal Care
Veterans
Physicians
Hospice Care
Neoplasms
Drug Therapy
Documentation
Logistic Models
Hospices
Critical Care
Pancreatic Neoplasms
Medical Records
Colorectal Neoplasms
Lung Neoplasms
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine
  • Nursing(all)

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Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer. / Ahluwalia, Sangeeta C.; Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney E; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

In: Journal of Palliative Medicine, Vol. 18, No. 10, 01.10.2015, p. 834-841.

Research output: Contribution to journalArticle

Ahluwalia, SC, Tisnado, DM, Walling, AM, Dy, SE, Asch, SM, Ettner, SL, Kim, B, Pantoja, P, Schreibeis-Baum, HC & Lorenz, KA 2015, 'Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer', Journal of Palliative Medicine, vol. 18, no. 10, pp. 834-841. https://doi.org/10.1089/jpm.2014.0431
Ahluwalia, Sangeeta C. ; Tisnado, Diana M. ; Walling, Anne M. ; Dy, Sydney E ; Asch, Steven M. ; Ettner, Susan L. ; Kim, Benjamin ; Pantoja, Philip ; Schreibeis-Baum, Hannah C. ; Lorenz, Karl A. / Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer. In: Journal of Palliative Medicine. 2015 ; Vol. 18, No. 10. pp. 834-841.
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abstract = "Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1{\%}), white (74.7{\%}), with an average age at diagnosis of 66.4 years. Approximately 31{\%} received some acute care, 9.3{\%} received some intensive intervention, and 6.5{\%} had a new chemotherapy regimen initiated in the last month of life. Approximately 41{\%} of decedents received no hospice or were admitted within three days of death. Almost half (46.8{\%}) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care.",
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AU - Ahluwalia, Sangeeta C.

AU - Tisnado, Diana M.

AU - Walling, Anne M.

AU - Dy, Sydney E

AU - Asch, Steven M.

AU - Ettner, Susan L.

AU - Kim, Benjamin

AU - Pantoja, Philip

AU - Schreibeis-Baum, Hannah C.

AU - Lorenz, Karl A.

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Y1 - 2015/10/1

N2 - Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care.

AB - Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care.

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