Blog | Wednesday, November 14, 2012

QD: News Every Day--End-of-life planning reduces aggressive treatment in a patient's last month of life


Early discussions of end-of-life planning (EOL) in patients with incurable cancer led to less chemotherapy in the last two weeks of life, and less time spent in the ICU and more time in a hospice setting, a study found.

Researchers studied 1,231 patients with stage IV lung or colorectal cancer who survived at least one month during the 15-month research period. Results appeared online Nov. 13 in the Journal of Clinical Oncology.

Nearly half of patients received at least one aspect of aggressive care, including chemotherapy in the last 14 days of life (16%), intensive care unit care in the last 30 days of life (9%), and acute hospital-based care in the last 30 days of life (40%).

But patients who had end-of-life planning talks before their last 30 days of life were less likely to receive aggressive measures at EOL, including chemotherapy (P=.003), acute care (P<.001), or any aggressive care (P<.001). Such patients were also more likely to receive hospice care (P<.001) and to have hospice initiated earlier (P<.001).

Researchers noted that discussions that begin in the last 30 days of life occur during the end-of-life period, and clinicians may not know when the last month of life is about to begin.

"However, physicians seem to wait until the patient begins deteriorating medically, a strategy that leads to a high incidence of inpatient discussions. Instead, physicians should consider moving conversations closer to diagnosis and initiating conversations while the patient is doing comparatively well, so the patient has time to plan for more difficult times in the future," the authors wrote. "Just as late discussions were associated with more aggressive EOL care, discussions in the inpatient hospital setting had similar outcomes. However, inpatient discussions may not necessarily cause more aggressive care; instead, once patients are hospitalized, EOL discussions may be expected."