From 2000 to 2012, more patients with cancer were found to be assigning durable power of attorney (52% compared with 74%), according to a study published in JAMA Oncology (2015; doi:10.1001/jamaoncol.2015.1976). However, no significant change was found in the use of living wills (49% compared with 40%) or end of life discussions (68% compared with 60%).

The study was conducted by Amol K. Narang, MD, of the Johns Hopkins School of Medicine in Baltimore, Maryland. Narang and coauthors examined trends in advance care planning with durable power of attorney (DPOA) assignment, the creation of living wills, and discussions of EOL care preferences.

The authors analyzed survey data from 1,985 next-of-kin surrogates, who were mainly partners, spouses, or children of Health and Retirement Study participants with cancer who died between 2000 and 2012. About 81% of those patients who died had engaged in at least one form of advance care planning.

Reports from surrogates that patients received “all care possible” at the end of life increased during the study period from 7% to 58%, although rates of terminal hospitalizations were unchanged (29% to 27%), the study reported.


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The limiting or withholding of treatment was associated with living wills and end-of-life discussions but not with DPOA assignment.

The authors noted a limitation of their study is that information on advance care planning and EOL treatment decisions came from proxies and not the patients.

“Without written or verbal direction, surrogate decision makers may struggle to make care decisions consistent with patient preferences,” the authors concluded.

“As such, policy and health system initiatives that support wider adoption of clinician-patient discussions of EOL care preferences are essential. In addition, these conversations must also include surrogate decision makers: efforts to educate surrogates on the goals, values, and care preferences of their loved ones have proven valuable across multiple chronic diseases and should be further explored in patients with advanced cancer.”