Advance care planning (ACP) prior to hematopoeitic stem cell transplantation (HSCT) in patients with cancer is associated with improved survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9026-9026 ◽  
Author(s):  
F. R. Loberiza ◽  
A. K. Ganti ◽  
J. O. Armitage ◽  
P. J. Bierman ◽  
R. G. Bociek ◽  
...  
Keyword(s):  
Life Support ◽  
Living Will ◽  
Power Of Attorney ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Diagnosis Of Cancer ◽  
Advance Care ◽  
Will Power ◽  
One Year ◽  
After Cancer

9026 Background: HSCT carries an increased risk of mortality. Thus, patients are encouraged to have ACP. However, discussions about ACP is not a casual process since it may elicit undue anxiety to the patients and their families. Anecdotally, pts fear that discussion of the possibility of death is inconsistent with hoping for the best outcome. We therefore compared the outcomes of pts with or without ACP who received HSCT for cancer. Methods: ACP was defined as having living will, power of attorney for health care, or life-support instructions conducted prior to transplant. ACP were reviewed in pts who were at least 19 yo and received first allogeneic or autologous HSCT for cancer between 2001 and 2003. Pts were classified into: 1) No ACP, 2) ACP prior to cancer dx, 3) ACP after cancer dx but prior to HSCT. Multivariate analysis (MVA) was done to evaluate the relative risk of mortality at 1 year according to ACP while adjusting for other prognostic factors. Results: 343 pts were included in the study: 172 (50%) did not have ACP, while 171 (50%) pts had ACP. Of those with ACP, 127 pts (74%) were available for review. Characteristics were similar between pts with and without reviewable ACP. 28 pts had ACP prior to cancer dx, 87 had ACP prior to HSCT, while 12 had ACP after HSCT. 64% of pts with ACP had both power of attorney and a living will, 16% had a living will alone and 19% had power of attorney alone. Older pts (p <0.001) and Caucasians (p = 0.04) were more likely to have ACP. MVA were confined to the 172 pts with no ACP and 115 who had ACP before HSCT and showed that pts with ACP prior to HSCT had a significantly lower risk of mortality (see table ). Conclusions: Despite a diagnosis of cancer and hospitalization for HSCT, only 50% of patients had engaged in ACP. ACP at any time before HSCT was associated with higher one-year survival. Engagement in ACP is not necessarily inconsistent with hoping for the best outcome in HSCT. Further study is warranted to explore the reasons for engaging or not in ACP. No significant financial relationships to disclose. [Table: see text]

scholarly journals Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Deborah Carr
Keyword(s):  
Life Expectancy ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Risk Of Death ◽  
Advance Care ◽  
Survival Expectations ◽  
The Impact

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

Health-Care Provider Personal Religious Preferences and Their Perspectives on Advance Care Planning With Patients

2018 ◽  
Vol 35 (12) ◽  
pp. 1565-1571
Author(s):  
Marjorie Bowman ◽  
Sarah St. Cyr ◽  
Adrienne Stolf i
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Affiliation ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Power Of Attorney ◽  
Religious Preference ◽  
Advance Care

Objective: To understand how health-care providers’ (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP’s involvement. Methods: Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs’ ACP participation. Results: 704 respondents: nurses (66.2%), physicians (18.8%), other HCPs (15.0%), white (88.9%), and primarily Catholic (23.3%) or Protestant (32.0%). “No religion” was marked by 13.9%. Respondents were favorable to ACP with patients. Religious respondents were more likely to have a living will ( P = .035) and health-care power of attorney ( P = .007) and more accepting of clergy as ACP decision coaches ( P = .030). HCP’s religion was not associated with willingness to facilitate ACP discussions. There were minor differences between Catholics and Protestants. Conclusions: Personal religious preference is associated with HCP’s own ACP but had little relationship with their willingness to facilitate ACP conversations with patients or acceptance of other professional types of HCPs involvement in ACP conversations. Regardless of religious affiliation, HCPs have interest in undertaking ACP and endorse other HCPs ACP involvement. As results of this study suggest that personal religious affiliation is not a barrier for HCPs engaging in ACP with patients, attempts to overcome barriers to increasing ACP should be directed to other factors.

Advance care planning among older LGBT Canadians: Heteronormative influences

Sexualities ◽  
2020 ◽  
pp. 136346071989696
Author(s):  
Brian de Vries ◽  
Gloria Gutman ◽  
Shimae Soheilipour ◽  
Jacqueline Gahagan ◽  
Áine Humble ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
Cultural Context ◽  
Death And Dying ◽  
Living Will ◽  
Community Dwelling ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advance Care

Advance care planning (ACP) in North America often takes place in a cultural context of great ambivalence about death and dying, challenging efforts to discuss end-of-life care desires and preparations for death. Such challenges are amplified for sexual and gender minority older adults who often lack connections to traditional heteronormative systems of support. The extent of ACP preparation (completed documents, discussions) and their predictors was examined among a national sample of 91 community-dwelling Canadian LGBT older adults (mean age 68). The sample was disproportionately single and lived alone; more trans participants had children and about half of all participants reported a chosen family. About two-thirds of participants had a will, while less than half had a living will and power of attorney for health care, and a quarter had made informal caregiving arrangements. Just over one-third of respondents reported having discussions about future care and end-of-life plans. The only significant predictors of both ACP documents completed and ACP discussions undertaken were relationship status (those in a relationship were more likely to have engaged in both) and number of children (those with children were less likely to have completed documents). Given that most LGBT older adults are single, efforts must be expanded to reach and engage these individuals in preparing for end of life.

Mortality after a proximal humeral fracture

2020 ◽  
pp. 1-7
Author(s):  
Carl Bergdahl ◽  
David Wennergren ◽  
Jan Ekelund ◽  
Michael Möller
Keyword(s):  
General Population ◽  
Proximal Humeral Fracture ◽  
Large Population ◽  
Humeral Fracture ◽  
Mortality Rates ◽  
Population Based ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Fracture Register ◽  
One Year

Aims The aims of this study were to investigate the mortality following a proximal humeral fracture. Data from a large population-based fracture register were used to quantify 30-day, 90-day, and one-year mortality rates after a proximal humeral fracture. Associations between the risk of mortality and the type of fracture and its treatment were assessed, and mortality rates were compared between patients who sustained a fracture and the general population. Methods All patients with a proximal humeral fracture recorded in the Swedish Fracture Register between 2011 and 2017 were included in the study. Those who died during follow-up were identified via linkage with the Swedish Tax Agency population register. Age- and sex-adjusted controls were retrieved from Statistics Sweden and standardized mortality ratios (SMRs) were calculated. Results A total of 18,452 patients who sustained a proximal humeral fracture were included. Their mean age was 68.8 years (16 to 107) and the majority (13,729; 74.4%) were women. A total of 310 (1.68%) died within 30 days, 615 (3.33%) within 90 days, and 1,445 (7.83%) within one year after the injury. The mortality in patients sustaining a fracture and the general population was 1,680/100,000 and 326/100,000 at 30 days, 3,333/100,000 and 979/100,000 at 90 days, and 7,831/100,000 and 3,970/100,000 at one year, respectively. Increasing age, male sex, low-energy trauma, type A fracture, concomitant fractures, and non-surgical treatment were all independent factors associated with an increased risk of mortality. Conclusion Compared with the general population, patients sustaining a proximal humeral fracture have a significantly higher risk of mortality up to one year after the injury. The risk of mortality is five times higher during the first 30 days, diminishing to two times higher at one year, suggesting that these patients constitute a strikingly frail group, in whom appropriate immediate management and medical optimization are required.

Abstract P323: Cardiac Rehabilitation is Associated With Decreased Mortality in HIV Patients With Cardiovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Justin M Bachmann ◽  
Suman Kundu ◽  
Kaku So-Armah ◽  
Amy Justice ◽  
Jason Sico ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Hiv Status ◽  
Hiv Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
One Year

Background: Human immunodeficiency virus (HIV+) patients are at high risk for cardiovascular disease (CVD). While cardiac rehabilitation (CR) reduces mortality in uninfected (HIV-) patients with CVD, there are no specific data on CR use in CVD patients with HIV. Methods: We analyzed data on 7650 veterans (28.4% HIV+) eligible for CR from the Veterans Aging Cohort Study, an observational cohort of HIV+ and HIV- veterans. CR eligibility was defined as a hospitalization for acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or cardiac valve surgery from 2003-2012, identified using ICD9 and CPT codes. CR use was ascertained from VA and non-VA facilities within one year of discharge from the index CVD hospitalization using CPT codes. We evaluated the association between CR and mortality after adjusting for age, eligibility diagnosis, race, sex, and comorbidities using Cox proportional hazard models. Results: CR use was low in HIV+ and HIV- veterans (9.1% vs. 9.6%, respectively, p=0.06). Among the 7650 CR eligible veterans, there were 2211 deaths over 25,715 person-years of follow-up. Mortality rates were higher among those who did not receive CR, regardless of HIV status (Figure). In adjusted models stratified by HIV status, CR was associated with a significant reduction in mortality for HIV+ (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.26-0.59) and HIV- veterans (HR 0.52, 95% CI 0.42-0.65). Among those receiving CR, HIV was not associated with an increased risk of mortality (Figure) even after adjusting for confounders (HR 1.01, 95% CI 0.63-1.61). Conclusions: CR utilization in both HIV+ and HIV- veterans is low. Participation in CR programs is associated with a significant reduction in mortality, regardless of HIV status. When CR is utilized, however, the risk of mortality is the same for HIV+ and HIV- veterans. CR may be particularly important for reducing mortality in HIV+ patients with CVD.

Ethnicity and Advance Care Directives

1996 ◽  
Vol 24 (2) ◽  
pp. 108-117 ◽  
Author(s):  
Sheila T. Murphy ◽  
Joycelynne M. Palmer ◽  
Stanley Azen ◽  
Gelya Frank ◽  
Vicki Michel ◽  
...  
Keyword(s):  
Health Care ◽  
Living Will ◽  
Power Of Attorney ◽  
Major Barrier ◽  
Positive Attitudes ◽  
Advance Care Directives ◽  
Advance Care ◽  
Advance Care Directive ◽  
End Of Life Decision ◽  
And Behavior

Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive (a living will), to name a surrogate to make those decisions (a durable power of attorney for health care), or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion.

scholarly journals Advance Care Planning and Advance Directives Completion of Elderly Patients at a Rural Health Clinic on a Regional Medical Campus

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Sarah Irvin ◽  
Melissa McGowan ◽  
Adrienne Zavala
Keyword(s):  
Rural Health ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Living Will ◽  
Health Clinic ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advanced Directives ◽  
Number Of Patients ◽  
Advance Care

Advance care planning is the shared decision-making process between physicians, patients, and families regarding the patient’s preferences for end of life care. These conversations increase compliance with patient wishes, decrease hospitalizations, increase deaths in patient’s preferred location, and decrease depression in surviving family members3. Even though there is proven benefit from advance care planning, these discussions are often overlooked. The purpose of this study is to evaluate rates of advance care planning and advance directive completion rate of 245 geriatric patients at our rural health clinic training site. We searched the electronic medical record to determine the number of patients who were asked about advance directives, stated they had a living will or medical power of attorney (MPOA), and had a living will or MPOA scanned into their chart. Out of the study population, 45% of patients stated they had some form of advanced directives. Of these patients, 22% and 25% had a living will and MPOA scanned into their chart, respectively. This study demonstrates the need for detailed discussion about advanced care planning with patients and additional follow-up to ensure documentation is readily available.  

Patient and caregiver characteristics related to completion of advance directives in terminally ill patients

2016 ◽  
Vol 15 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Grace W.K. Ho ◽  
Lauren Skaggs ◽  
Gayane Yenokyan ◽  
Anela Kellogg ◽  
Julie A. Johnson ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Convenience Sample ◽  
Advance Care ◽  
Lateral Sclerosis

AbstractObjective:There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.Method:A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.Results:Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.Significance of results:Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.

Racial Differences in End-Of-Life Planning: Why Don'T Blacks and Latinos Prepare for the Inevitable?

2011 ◽  
Vol 63 (1) ◽  
pp. 1-20 ◽  
Author(s):  
Deborah Carr
Keyword(s):  
End Of Life ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Ethnic Disparities ◽  
Chronically Ill ◽  
Living Will ◽  
Treatment Preferences ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advance Care

I evaluate the extent to which ethnic disparities in advance care planning reflect cultural and religious attitudes and experience with the painful deaths of loved ones. Data are from a sample of 293 chronically ill older adults who are seeking care at one of two large medical centers in urban New Jersey. Blacks and Hispanics are significantly less likely than Whites to have a living will, a durable power of attorney for health care (DPAHC), and to have discussed their end of life treatment preferences. Multivariate analyses reveal that the Black-White gap in advance care planning is largely accounted for by Blacks' belief that God controls the timing and nature of death. The Hispanic-White gap is partially accounted for by the belief that one's illness negatively affects one's family. Ethnic disparities are starkest for living will and DPAHC use, and less pronounced for discussions. Implications for policy and practice are discussed.

Understanding patient advance directives status in a community oncology practice using an electronic patient-reported outcomes (ePRO) system.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23181-e23181
Author(s):  
Joanne S. Buzaglo ◽  
Karen E Skinner ◽  
Edward Stepanski ◽  
Cynthia Tankersley ◽  
Lee S. Schwartzberg
Keyword(s):  
Cancer Patients ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Initial Visit ◽  
Power Of Attorney ◽  
Durable Power Of Attorney ◽  
Advance Care ◽  
Oncology Practice

e23181 Background: The National Comprehensive Cancer Network and the American Society of Clinical Oncology recommend that providers encourage early advance care planning with their patients1; yet, many cancer patients do not have advance directives (ADs). A potential reason for low AD rates is inadequate communication between the provider and patient. To address this gap, we developed an outpatient clinic AD initiative for any stage cancer patients via an ePRO system. The AD module was designed to ensure that patients are aware of ADs and to assess whether or not the patient had ADs, specifically a Living Will and/or a durable power of attorney. The study purpose was to assess patient AD status at the patient’s initial visit to an oncology clinic. Methods: This study used a retrospective, observational design that involved use of PRO and clinical data collected via the Patient Care Monitor™ (PCM), a web-based ePRO system linked to electronic medical record data. All data used in this study were collected as part of routine clinical care. All patients at an initial visit to an oncology clinic completed the PCM survey, including the AD module, via a handheld e-tablet. Results: Overall, 9,682 patients completed the AD module (mean age 63; 31% male/69% female; 58% married; 62% White, 35% Black). Cancer type was known for 75% of all patients (29% breast, 11% hematologic, 7% lung, 7% colorectal, 3% prostate, 17% other types). One third of all patients (33%) reported having an AD at the time of the initial visit to the oncology clinic, specifically 24% indicated having a Living Will and 9% a durable power of attorney. The remaining two-thirds (67%) indicated either NOT having an AD (56%) or not knowing if they had an AD (11%). Patients with ADs were more likely to be older ( M=68 v. 60 yrs), male (38% v 31%), White (41% v 20% Black) and married/partnered (35% v 29%); ps <.0001. Conclusions: This study demonstrates that the majority of patients do not have ADs at the time of an initial visit to a community-based oncology practice. Using an ePRO system can be an innovative and efficient way to identify unmet needs of patients and link them to resources for developing advance directives. 1Brown AJ, Shen MJ, Urbauer D, et al. Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients. Gynecol Oncol. Sep 2016;142(3):525-530.

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