Influence of patients' preferences and treatment site on cancer patients' end-of-life care. Academic Article Article uri icon

Overview

MeSH

  • Aged
  • Cancer Care Facilities
  • Female
  • Hospices
  • Humans
  • Life Expectancy
  • Male
  • Middle Aged
  • Physician-Patient Relations
  • Prospective Studies

MeSH Major

  • Neoplasms
  • Patient Preference
  • Terminal Care

abstract

  • Research suggests that patients' end-of-life (EOL) care is determined primarily by the medical resources available, and not by patient preferences. The authors examined whether patients' desire for life-extending therapy was associated with their EOL care. Coping with Cancer is a multisite, prospective, longitudinal study of patients with advanced cancer. Three hundred one patients were interviewed at baseline and followed until death, a median of 4.5 months later. Multivariate analyses examined the influence of patients' preferences and treatment site on whether patients received intensive care or hospice services in the final week of life. Eighty-three of 301 patients (27.6%) with advanced cancer wanted life-extending therapy at baseline. Patients who understood that their disease was terminal or who reported having EOL discussions with their physicians were less likely to want life-extending care compared with others (23.4% vs 42.6% and 20.7% vs 44.4%, respectively; P≤.003). Patients who were treated at Yale Cancer Center received more intensive care (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.16-8.47) and less hospice services (OR, 0.52; 95% CI, 0.29-0.92) compared with patients who were treated at Parkland Hospital. However, in multivariate analyses that controlled for confounding influences, patients who preferred life-extending care were more likely to receive intensive care (adjusted OR [AOR], 2.91; 95% CI, 1.09-7.72) and were less likely to receive hospice services (AOR, 0.45; 95% CI, 0.26-0.78). Treatment site was not identified as a significant predictor of EOL care. The treatment preferences of patients with advanced cancer may play a more important role in determining the intensity of medical care received at the EOL than previously recognized. Future research is needed to determine the mechanisms by which patients' preferences for care and treatment site interact to influence EOL care. Copyright © 2010 American Cancer Society.

publication date

  • October 1, 2010

has subject area

  • Aged
  • Cancer Care Facilities
  • Female
  • Hospices
  • Humans
  • Life Expectancy
  • Male
  • Middle Aged
  • Neoplasms
  • Patient Preference
  • Physician-Patient Relations
  • Prospective Studies
  • Terminal Care

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC3670423

Digital Object Identifier (DOI)

  • 10.1002/cncr.25217

PubMed ID

  • 20572030

Additional Document Info

start page

  • 4656

end page

  • 4663

volume

  • 116

number

  • 19