Aggressiveness of care was scored with a composite aggressiveness index based on previously established indices of aggressiveness of care in the last 30 days of life. These indices included more than 1 emergency department visit, more than 1 hospitalization, any intensive care unit admission, new chemotherapy, any chemotherapy in the last 14 days of life, and less than 3 days’ stay at hospice. The index was calculated as a score of 1 point for each of the 6 indices, for a total score of 0 to 6. Higher scores indicated more aggressive treatment at the end of life.

Patients and oncologists were surveyed every 3 months for the 15 months of the study, surveys ended early if the patient died or was transferred to hospice. Of the patients who agreed to participate, 206 patients died during the study period. Within the study, 72.3% of patients were white, the average patient age was 64.1 years, 51.0% of patients were female, and 75.2% of patients had a new diagnosis of cancer. More than half (53.5%) of patients included in the study used palliative care services during the study period and 63.4% had an advance directive.

At the last interview before death, 23.3% of the studied patient–oncologist dyads had strong goal of care agreement for survival (8.3%) or comfort (15%).


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However, 76.7% of the dyads did not have strong agreement regarding goals of care. Goal of care scores differed by 50 points or more in 11 (7.1%) dyads in which the patient scored survival higher than the oncologist and in 21 (13.5%) dyads in which the oncologist scored survival higher than the patient.

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Composite aggressiveness index showed that 53.4% of patients did not receive any aggressive care. Use of aggressive care was associated with strong agreement between patient and oncologist regarding goals of care by category. Use of at least 1 aggressive treatment was used in 64.7% of dyads with strong agreement for goals of care for survival, 29% in dyads with strong agreement for comfort, and 34.2% in dyads with no strong agreement.

“Given the relationship between dyadic concordance and use of aggressive care at EOL and the large number of dyads with no concordance regarding goals of care, it is recommended that patients’ goals of care be measured early and often,” the authors concluded.

Reference

Douglas SL, Daly BJ, Lipson AR, Blackstone E. Association between strong patient-oncologist agreement regarding goals of care and aggressive care at end-of-life for patients with advanced cancer [published online February 6, 2020]. Support Care Cancer. doi: 10.1007/s00520-020-05352-w