Importance and Timing of End-of-Life Care Discussions Among Gynecologic Oncology Patients

2012 ◽  
Vol 30 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Teresa P. Díaz-Montes ◽  
Megan K. Johnson ◽  
Robert L. Giuntoli ◽  
Alaina J. Brown
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Disease Status ◽  
Optimal Timing ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Contingency Analysis ◽  
Advanced Directives

Objectives: To assess the importance and desired timing of end-of-life care (EOLC) discussions among women with gynecologic cancer. Methods: A questionnaire related to EOLC issues was distributed to patients with gynecologic cancer. Answers were analyzed via SPSS using descriptive statistics. Contingency analysis was done to evaluate for differences among disease status and age regarding preferences for timing of discussions. Results: Patients expressed that addressing EOLC is an important part of their treatment. Most patients were familiar with advanced directives (73.0%), do not resuscitate/do not intubate (88.5%), and hospice (97.5%). Designating someone to make decisions was significantly related to disease status ( P = .03) and age ( P = 0.02). Conclusions: Patients are familiar with basic EOLC with optimal timing for discussions at disease progression or when treatment is no longer available.

scholarly journals Does Death Anxiety Affect End-of-Life Care Discussions?

2014 ◽  
Vol 24 (8) ◽  
pp. 1521-1526 ◽  
Author(s):  
Alaina J. Brown ◽  
Megan J. Shen ◽  
Lois M. Ramondetta ◽  
Diane C. Bodurka ◽  
Robert L. Giuntoli ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death Anxiety ◽  
Linear Regression Analysis ◽  
Gynecologic Oncology ◽  
Family Members ◽  
Comfort Level ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders

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.

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.

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.

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

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.

scholarly journals Race Does Not Influence Do-Not-Resuscitate Status or the Number or Timing of End-of-Life Care Discussions at a Pediatric Oncology Referral Center

2009 ◽  
Vol 12 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Justin N. Baker ◽  
Shesh Rai ◽  
Wei Liu ◽  
Kumar Srivastava ◽  
Javier R. Kane ◽  
...  
Keyword(s):  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Referral Center

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

2017 ◽  
Vol 145 ◽  
pp. 23
Author(s):  
M.M. Mullen ◽  
L.M. Divine ◽  
B. Porcelli ◽  
I. Wilkinson-Ryan ◽  
M. Dans ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Life Care ◽  
Oncology Patients

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

2022 ◽  
pp. 088506662110690
Author(s):  
Daniel King ◽  
Erica Schockett ◽  
Ghazi Rizvi ◽  
Daniel Fischer ◽  
Richard Amdur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Univariate Analysis ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Comfort Care ◽  
Over Time

Objective Dying in the intensive care unit (ICU) has changed over the last twenty years due to increased utilization of palliative care. We sought to examine how palliative medicine (PM) integration into critical care medicine has changed outcomes in end of life including the utilization of do not resuscitate (no cardiopulmonary resuscitation but continue treatment) and comfort care orders (No resuscitation, only comfort medication). Design: Retrospective observational review of critical care patients who died during admission between two decades, 2008 to 09 and 2018 to 19. Setting: Single urban tertiary care academic medical center in Washington, D.C. Patients: Adult patients who were treated in any ICU during the admission which they died. Interventions and Measurements We sought to measure PM involvement across the two decades and its association with end of life care including do not resuscitate (DNR) and comfort care (CC) orders. Main Results: 571 cases were analyzed. Mean age was 65 ± 15, 46% were female. In univariate analysis significantly more patients received PM in 2018 to 19 (40% vs. 27%, p = .002). DNR status increased significantly over time (74% to 84%, p = .002) and was significantly more common in patients who were receiving PM (96% vs. 72%, p < 0.001). CC also increased over time (56% to 70%, p = <0.001), and was more common in PM patients (87% vs. 53%, p < 0.001). Death in the ICU decreased significantly over time (94% to 86%, p = .002) and was significantly lower in PM patients (76% vs. 96%, p < 0.001). The adjusted odds of getting CC for those receiving versus those not receiving PM were 14.51 (5.49-38.36, p < 0.001) in 2008 to 09 versus 3.89 (2.27-6.68, p < 0.001) in 2018 to 19. Conclusion: PM involvement increased significantly across a decade in our ICU and was significantly associated with incidence of DNR and CC orders as well as the decreased incidence of dying in the ICU. The increase in DNR and CC orders independent of PM over the past decade reflect intensivists delivering PM services.

The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation

2008 ◽  
Vol 36 (1) ◽  
pp. 119-140 ◽  
Author(s):  
Susan E. Hickman ◽  
Charles P. Sabatino ◽  
Alvin H. Moss ◽  
Jessica Wehrle Nester
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Treatment Preferences ◽  
Life Care ◽  
Legal Analysis ◽  
Do Not Resuscitate ◽  
Term Care ◽  
Treatment Paradigm ◽  
Life Sustaining Treatment ◽  
Legal Barriers

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR (do not resuscitate) protocols (n = 9 states). Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments (n = 23 states), medical preconditions (n = 15), and witnessing requirements (n = 12) for out-of-hospital DNR protocols.

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