End of Life Care at a Gynecologic Oncology Unit

ObjectivesThe aim of this study was to determine if a gynecologic cancer patient’s comfort level discussing end-of-life care issues with her caregivers is related to her death anxiety level.Materials/MethodsGynecologic oncology clinic patients were asked to rate their degree of agreeability with 4 statements regarding comfort level discussing end-of-life care issues. Participants also completed the Hoge’s Intrinsic Religiosity Scale and Templer’s Death Anxiety Scale.ResultsFour hundred one surveys were distributed. One hundred twenty-nine patients participated, with a response rate of 32.2%. The median age of the sample was 55 years. Most patients were white (72.9%), married (58.9%), and Christian (85.3%). Most patients had ovarian cancer (40.4%). Of the 74 patients who knew their cancer stage, 59% had been diagnosed with advanced (stage III-IV) disease. Thirty-three percent were currently in remission, and 17% had recurrent disease. Of all patients surveyed, 32.6% were currently receiving treatment. Chemotherapy was the most common treatment (62% of those being treated). Higher level of comfort discussing end-of-life care topics such as do-not-resuscitate orders with family members was significantly associated with decreased death anxiety (P = 0.008 and P = 0.001). There was no significant association between comfort level when patients discussed do-not-resuscitate orders with physicians and patients’ death anxiety (P = 0.14). After controlling for age, race, marital status, education level, current treatment status, and religiosity, linear regression analysis demonstrated that the relationship between a patient’s increased comfort level when discussing end-of-life care topics with family members and decreased death anxiety remained statistically significant (P = 0.005 and P = 0.001).ConclusionsConversations regarding goals of treatment are an important component of caring for cancer patients. Death anxiety may contribute to decreased communication between patients and their family members regarding the patient’s end-of-life care wishes. Obtaining a better understanding of the role death anxiety plays in end-of-life care discussions may help patients receive the end-of-life care they desire.

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The nurses perspective of the effectiveness and value of the respiratory distress observation scale.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.139 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 139-139

Author(s):

Kerstin Scheper

Keyword(s):

Focus Group ◽

Respiratory Distress ◽

End Of Life ◽

End Of Life Care ◽

Medical Center ◽

Self Report ◽

Pharmacological Intervention ◽

Life Care ◽

Observation Scale ◽

Oncology Unit

139 Background: The nurses on the oncology unit at Overlook Medical Center have been using the Respiratory Distress Observation Scale (RDOS) since September 2013 to assess and manage respiratory distress and dyspnea at end of life for our cognitively impaired patients. The gold standard for managing dyspnea has been the ability of the patient to self-report. Cognitive impairment may interfere with the assessment of respiratory distress and dyspnea leading to under recognition and under or over medication of symptoms. Methods: A nurse focus group was formed and elicited discussion, information, and opinion of the implementation and effectiveness of the RDOS on the medical oncology unit. The nurses were tasked with identifying if the RDOS improved their ability to assess and manage respiratory symptoms for this patient population. The group consisted of eight nurses from the oncology unit who shared a passion for end of life care, but varied in levels of expertise and years of experience. The participants answered nine open-ended questions relating to the implementation and effectiveness of the RDOS, its use in communicating with patient’s family, and their experiences with end of life care both on their unit and throughout the hospital. Approximately fifty six patients were evaluated with the RDOS by these nurses prior to the focus group meeting. Results: All participants stated the RDOS was easy, took two minutes to perform and has improved their ability to assess and manage dyspnea while enhancing their ability to effectively communicate with physicians. All were passionate in their belief that the RDOS is a tool that validates their decision to medicate and facilitates educating families that may be resistant to pharmacological intervention. Conclusions: Our focus group results were similar to research findings identifying the RDOS as effective in managing dyspnea. The group advocated its use and support implementation of the RDOS house wide. The group produced useful information and elicited candid discussion on its ability to favorably impact care.

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The effect of a multidisciplinary palliative care initiative on end of life care in gynecologic oncology patients

Gynecologic Oncology ◽

10.1016/j.ygyno.2017.08.002 ◽

2017 ◽

Vol 147 (2) ◽

pp. 460-464 ◽

Cited By ~ 5

Author(s):

Mary M. Mullen ◽

Laura M. Divine ◽

Bree P. Porcelli ◽

Ivy Wilkinson-Ryan ◽

Maria C. Dans ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Gynecologic Oncology ◽

Life Care ◽

Oncology Patients

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How equal is end-of-life care among gynecologic oncology patients?

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.490 ◽

2015 ◽

Vol 137 ◽

pp. 194-195

Author(s):

J.S. Taylor ◽

A.J. Brown ◽

L.S. Prescott ◽

C.C.L. Sun ◽

L.M. Ramondetta ◽

...

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Gynecologic Oncology ◽

Life Care ◽

Oncology Patients

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Managing symptoms when “the first step or two isn’t working”: Provider and patient perceptions of the role of specialty palliative care in symptom management in gynecologic oncology.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.47 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 47-47

Author(s):

Carolyn Lefkowits ◽

Dio Kavalieratos ◽

Janet Arida ◽

Winifred Teuteberg ◽

Heidi Donovan ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Care Provider ◽

Symptom Management ◽

End Of Life Care ◽

Gynecologic Oncology ◽

Gynecologic Cancer ◽

Life Care ◽

Multiple Symptoms

47 Background: Our objective was to describe gynecologic oncology (GO) providers’ and patients’ knowledge, attitudes and preferences related to utilization of specialist palliative care (SPC) for symptom management. Methods: Semi-structured qualitative interviews with 19 GO providers (7 physicians, 7 advanced practice providers, 5 nurses) and 30 patients with advanced or recurrent gynecologic cancer from an academic medical center. Key interview domains include: patient symptoms, perceived role of oncology team regarding symptom management, familiarity with SPC, and barriers and facilitators to utilization of SPC for symptom management. Qualitative analysis is underway. Results: 19 provider interviews and 29 patient interviews were completed. Preliminary findings indicate shared beliefs between providers and patients, including an overall willingness to involve SPC in symptom management. Although providers felt comfortable initially managing common symptoms, they expressed interest in involving SPC for complex or multiple symptoms. Patients do not expect their GO providers to manage severe symptoms, noting concerns of complex symptom management as burdensome to the GO team. Barriers to involving SPC in symptom management included: patients’ perceptions of SPC as synonymous with end-of-life care, and logistical issues (e.g., scheduling and transportation). When a distinction was drawn between SPC for symptom management and end-of-life care, patients were uniformly open to seeing SPC for symptom management. Conclusions: GO patients’ and providers’ perception of the role of oncology providers in symptom management is consistent with the concept of a primary palliative care provider, delivering initial management of common symptoms. Specialty palliative care services are seen as complementary to the GO providers’ skillset and particularly useful for severe or multiple symptoms. Implications include the importance of ensuring that oncology provider training includes dedicated attention to symptom management to enable them to fulfill the role of primary palliative care provider.

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Dying well: How equal is end of life care among gynecologic oncology patients?

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.12.012 ◽

2016 ◽

Vol 140 (2) ◽

pp. 295-300 ◽

Cited By ~ 13

Author(s):

Jolyn S. Taylor ◽

Alaina J. Brown ◽

Lauren S. Prescott ◽

Charlotte C. Sun ◽

Lois M. Ramondetta ◽

...

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Gynecologic Oncology ◽

Life Care ◽

Oncology Patients

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End-of-life care planning in patients with recurrent gynecologic cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20648 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20648-e20648

Author(s):

Nathan L Jones ◽

Shelley L Galvin ◽

Timothy J Vanderkwaak ◽

David J. Hetzel ◽

Cameron Blair Harkness ◽

...

Keyword(s):

Ovarian Cancer ◽

Palliative Care ◽

End Of Life ◽

Median Duration ◽

End Of Life Care ◽

Gynecologic Oncology ◽

Care Plan ◽

Life Care ◽

Do Not Resuscitate ◽

Gynecologic Cancers

e20648 Background: Gynecologic oncologists and associates must provide appropriate, acceptable, and patient-centered end-of-life care. Most women with terminal gynecologic cancers do not have do-not-resuscitate (DNR) orders upon hospital admission and many do not receive effective palliative care. Our objective was to assess quality care indicators involving end-of-life care among gynecologic oncology patients treated at our institution. Methods: An IRB-approved retrospective chart review was performed on all patients with recurrent gynecologic cancers and terminal diagnoses who died from January 2009 through October 2012. Data included intervals to death from: diagnoses, DNR status, Hospice/Palliative Care Medicine (HPCM) involvement, and other factors related to end-of-life care. Chi-squared and discriminate analyses were utilized. Results: Complete data were available for 130 of 345 (37.7%) patients. Disease sites included cervix 28 (21.5%), uterine 37 (28.5%), ovarian 51(39.2%), and vaginal/vulvar 14 (10.8%). Median age at diagnosis and death was 63 and 65 years. Relative to death, diagnoses occurred at a median of 1.65 (0.05-32) years prior. 83 (63.8%) patients were DNR at their last hospitalization, 84(64.6%) had HPCM involvement, and 18(13.8%) had an advance care plan. When HPCM was involved, 83.3% were DNR as compared to 28.3% without involvement (p=0.0001). Patients were also significantly more likely to have DNR status with diagnosis of ovarian cancer and as the duration of time between diagnosis and death increased (p=0.0001). The provider obtaining DNR was most often faculty over residents or HPCM (60.2%, 27.7%, 12%). DNR status was declared by 57 (68.7%) patients and 26 (31.3%) power of attorneys. Median duration from DNR to death was 14 days (0-308) and median duration from HPCM involvement to death was 22 days (0-391). Conclusions: DNR status is associated with ovarian cancer, HPCM involvement, and increasing time from diagnosis to death. Earlier intervention from providers or HPCM could allow for greater patient autonomy and fewer interventions at end-of-life.

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