Aligning Patient Goals With End of Life Treatment Decisions

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Some patients may be at risk for receiving end-of-life care that is not congruent with their preferences and goals.
Some patients may be at risk for receiving end-of-life care that is not congruent with their preferences and goals.

Greater attention may be warranted to ensure end-of-life care is congruent with a cancer patient's preferences, according to researchers at Case Western Reserve University. Their findings were reported at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting and indicated that that some patients may be at risk for receiving end-of-life care that is not congruent with their preferences and goals.

Sara L. Douglas, PhD, RN, of the Case Western Reserve University Frances Payne Bolton  School of Nursing in Cleveland, Ohio, and colleagues conducted a longitudinal study with 378 patients with stage IV gastrointestinal or lung cancer.

The researchers surveyed each patient and their physician every 3 months for 15 months or until the patient died. Using a visual analog scale (VAS), the researchers examined patients' preferences regarding care and how those preferences aligned with outcomes.

The mean age of the patients was 64 years (range: 36 - 88 years) and the mean time from study enrollment until death was 6.5 months (range: 3 - 25 months). In this study, 66% of patients had gastrointestinal cancer and 34% had lung cancer.

The researchers found that when there was strong agreement between the physician and the patient on goals (either survival or comfort) the level of aggressiveness of care that were reflective of their goals. The study showed that when patients and their physicians agreed on the goal of survival, 90% of the patients received at least one indicator of aggressive treatment. However, when there were differences in goals, patients were found to be at risk of receiving care that was not congruent with their preferences and goals of care. Their findings emphasize the needs to align goals of care between patients and physicians.

Reference

1. Douglas SL, Daly BJ, Meropol NJ, et al. Aligning goals of care with aggressiveness at end of life (EOL). J Clin Oncol. 2018;36:(suppl; abstr 10026).

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