Is There an Appropriate Time for the End-of-Life Care Discussion?

A majority of patients with incurable cancer talk with a physician about options for care at the end of life. Yet, according to a study by Dana-Farber Cancer Institute, this discussion often does not take place until late in the course of the illness.

“Previous studies have shown that patients who discuss their end-of-life care preferences with a physician are more likely to choose palliative, comfort-focused care over aggressive measures, and receive hospice or other care consistent with their wishes,” says the study’s lead author, Jennifer Mack, MD, MPH, of Dana-Farber/Children’s Hospital Cancer Center. “But studies haven’t looked at the timing of these discussions, or where and with whom they occur.”

Study data were gathered from the Cancer Outcomes Research and Surveillance Consortium (CanCORS), a multi-region, population- and health system-based study of more than 10,000 patients with lung or colorectal cancer. At 2 time points, researchers interviewed patients. Then, medical records were analyzed 15 months after diagnosis. After evaluating medical records and interviews, researchers discovered that 73% of the 2155 patients with stage IV lung or colorectal cancer involved in the study had an end-of-life care talk with a physician. Among the nearly 1000 patients who passed away and whose records document an end-of-life care discussion with a physician, the median time of those discussions was just 33 days before death.

Researchers went on to study the location of those discussions and the type of physician involved. Of the more than 1000 end-of-life care discussions in the medical records, 55% occurred in the hospital. In the study, oncologists documented end-of-life care talks with only 27% of their terminally ill patients.

“It’s encouraging to see such a high percentage of patients had end-of-life care conversations with a physician,” Mack says. “There’s a concern, though, that so many of these talks are taking place late in the trajectory of the disease.”

Source: Dana-Farber Cancer Institute.