Advanced Care Planning Documentation Facilitates Better Quality of Life for Terminal Cancer Patients

For patients with end-stage cancer, advanced care planning (ACP) documentation can prevent avoidable hospital admissions at the end of life (EOL), according to researchers from Ohio State University who published their findings in the American Journal of Hospice and Palliative Medicine.

Once a terminally ill patient transitions into hospice care, the goal is to avoid hospitalizations and procedures that are unnecessary and unwanted,” said Dr. Laura Prater, MPH, MHA, the study’s lead author and a postdoctoral researcher in the Division of General Internal Medicine at Ohio State’s College of Medicine in a press release about the study.

Previous studies have uncovered that more than half of terminally ill patients have insufficient documentation of ACP present in their electronic health records (EHRs), and for those who do, the ease of finding that documentation is inconsistent.

In this retrospective cohort study, researchers used EHR data to assess the likelihood of hospital readmission among 1,185 patients at a large academic medical center with a primary cancer diagnosis, who were referred to hospice care between January 2014 and December 2015. To quantify covariates between those with and without advanced ACP at baseline, the researchers used inverse probability treatment weighing based on calculated propensity scores. Odds ratios (ORs) were used to gauge the impact of ACP on admissions in the final 30 days of life.

The Importance of Documenting Patients’ Wishes

According to the results of the study, patients with an order of a verified do-not-resuscitate (DNR) prior to the last 30 days of life had diminished odds of unnecessary admission compared to those without a DNR (OR = 0.30; P < .001). Moreover, the results suggest that patients with an ACP note in their “problem list” before the final 30 days of life had decreased odds of admission juxtaposed to patients without an ACP note (OR=0.71, P=.042) and further diminished odds if the ACP was completed six months prior to death (OR=0.35, P<.001). “These study results really support the idea that earlier is better for documenting these wishes,” Dr. Prater continued. “Those who had advanced care planning notes in their health records six months or more before a hospital trip were significantly less likely to be admitted.”

Dr. Prater concluded by stating that her team’s research “supports the importance of sharing your wishes with your physician and your family and suggests that doing that earlier can prevent unwanted procedures and hospitalizations that don’t align with your priorities and deteriorate your quality of life.”

Source: American Journal of Hospice and Palliative Medicine, EurekAlert