Paradoxes in advance care planning: The Complex relationship of oncology patients, their physicians, and advance medical directives

Lindsay A. Dow, Robin K. Matsuyama, V. Ramakrishnan, Laura Kuhn, Elizabeth B. Lamont, Laurel Lyckholm, Thomas J Smith

Research output: Contribution to journalArticle

Abstract

Purpose: Many seriously ill patients with cancer do not discuss prognosis or advance directives (ADs), which may lead to inappropriate and/or unwanted aggressive care at the end of life. Ten years ago, patients with cancer said they would not like to discuss ADs with their oncologist but would be willing to discuss them with an admitting physician. We assessed whether this point of view still held. Patients and Methods: Semi-structured interviews were conducted with 75 consecutively admitted patients with cancer in the cancer inpatient service. Results: Of those enrolled, 41% (31 of 75) had an AD. Nearly all (87%, 65 of 75) thought it acceptable to discuss ADs with the admitting physician with whom they had no prior relationship, and 95% (62 of 65) thought that discussing AD issues was very or somewhat important. Only 7% (5 of 75) had discussed ADs with their oncologist, and only 23% (16 of 70) would like to discuss ADs with their oncologist. When specifically asked which physician they would choose, 48% (36 of 75) of patients would prefer their oncologist, and 35% (26 of 75) would prefer their primary care physician. Conclusion: Fewer than half of seriously ill patients with cancer admitted to an oncology service have an AD. Only 23% (16 of 70) would like to discuss their ADs with their oncologist but nearly all supported a policy of discussing ADs with their admitting physician. However, fully 48% (36 of 75) actually preferred to discuss advance directives with their oncologist if AD discussion was necessary. We must educate patients on why communicating their ADs is beneficial and train primary care physicians, house staff, hospitalists, and oncologists to initiate these difficult discussions.

Original languageEnglish (US)
Pages (from-to)299-304
Number of pages6
JournalJournal of Clinical Oncology
Volume28
Issue number2
DOIs
StatePublished - Jan 10 2010
Externally publishedYes

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Advance Care Planning
Advance Directives
Physicians
Primary Care Physicians
Neoplasms
Hospitalists
Terminal Care
Internship and Residency
Oncologists

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Paradoxes in advance care planning : The Complex relationship of oncology patients, their physicians, and advance medical directives. / Dow, Lindsay A.; Matsuyama, Robin K.; Ramakrishnan, V.; Kuhn, Laura; Lamont, Elizabeth B.; Lyckholm, Laurel; Smith, Thomas J.

In: Journal of Clinical Oncology, Vol. 28, No. 2, 10.01.2010, p. 299-304.

Research output: Contribution to journalArticle

Dow, Lindsay A. ; Matsuyama, Robin K. ; Ramakrishnan, V. ; Kuhn, Laura ; Lamont, Elizabeth B. ; Lyckholm, Laurel ; Smith, Thomas J. / Paradoxes in advance care planning : The Complex relationship of oncology patients, their physicians, and advance medical directives. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 2. pp. 299-304.
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abstract = "Purpose: Many seriously ill patients with cancer do not discuss prognosis or advance directives (ADs), which may lead to inappropriate and/or unwanted aggressive care at the end of life. Ten years ago, patients with cancer said they would not like to discuss ADs with their oncologist but would be willing to discuss them with an admitting physician. We assessed whether this point of view still held. Patients and Methods: Semi-structured interviews were conducted with 75 consecutively admitted patients with cancer in the cancer inpatient service. Results: Of those enrolled, 41{\%} (31 of 75) had an AD. Nearly all (87{\%}, 65 of 75) thought it acceptable to discuss ADs with the admitting physician with whom they had no prior relationship, and 95{\%} (62 of 65) thought that discussing AD issues was very or somewhat important. Only 7{\%} (5 of 75) had discussed ADs with their oncologist, and only 23{\%} (16 of 70) would like to discuss ADs with their oncologist. When specifically asked which physician they would choose, 48{\%} (36 of 75) of patients would prefer their oncologist, and 35{\%} (26 of 75) would prefer their primary care physician. Conclusion: Fewer than half of seriously ill patients with cancer admitted to an oncology service have an AD. Only 23{\%} (16 of 70) would like to discuss their ADs with their oncologist but nearly all supported a policy of discussing ADs with their admitting physician. However, fully 48{\%} (36 of 75) actually preferred to discuss advance directives with their oncologist if AD discussion was necessary. We must educate patients on why communicating their ADs is beneficial and train primary care physicians, house staff, hospitalists, and oncologists to initiate these difficult discussions.",
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