Journal
CANCER
Volume 116, Issue 4, Pages 998-1006Publisher
WILEY
DOI: 10.1002/cncr.24761
Keywords
end-of-life care; prognosis; hospice; physician survey
Categories
Funding
- National Cancer Institute (NCI) [U01 CA093344, U01 CA093332]
- Harvard Medical School/Northern California Cancer Center [U01 CA093324]
- RAND/UCLA [U01 CA093348]
- University of Alabama at Birmingham [U01 CA093329]
- University of Iowa [U01 CA01013]
- Universicy of North Carolina [U01 CA093326]
- Department of Veteran's Affairs [CDA093344, 03-438MO-03]
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BACKGROUND: Guidelines recommend advanced care planning for terminally ill patients with <1 year to live. Few data are available regarding when physicians and their terminally ill patients typically discuss end-of-life issues. METHODS: A national survey was conducted of physicians caring for cancer patients about timing of discussions regarding prognosis, do not resuscitate (DNR) status, hospice, and preferred site of death with their terminally ill patients. Logistic regression was used to identify physician and practice characteristics associated with earlier discussions. RESULTS: Among 4074 respondents, 65% would discuss prognosis now (defined as patient has 4 months to 6 months to live, asymptomatic). Fewer would discuss DNR status (44%), hospice (26%), or preferred site of death (21%) immediately, with most physicians waiting for patient symptoms or until there are no more treatments to offer. In multivariate analyses, younger physicians more often discussed prognosis, DNR status, hospice, and site of death now (all P < .05). Surgeons and oncologists were more likely than noncancer specialists to discuss prognosis now (P = .008), but noncancer specialists were more likely than cancer specialists to discuss DNR status, hospice, and preferred site of death now (all P < .001). CONCLUSIONS: Most physicians report they would not discuss end-of-life options with terminally ill patients who are feeling well, instead waiting for symptoms or until there are no more treatments to offer. More research is needed to understand physicians' reasons for timing of discussions and how their propensity to aggressively treat metastatic disease influences timing, as well as how the timing of discussions influences patient and family experiences at the end of life. Cancer 2010;116:998-1006. (C) 2070 American Cancer Society.
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