End-of-Life Care: Clarify Goals While Mental Clarity Is Present

Maura George, MD

Only half of terminally ill hospitalized patients participated in advanced directive discussions.

In most terminally ill cancer patients, discussions about end-of-life care first are broached in the hospital setting. However, we know little about these conversations.

Researchers at a single center in Michigan performed a retrospective cohort study of adult patients with advanced cancer who died during their hospitalizations between 2004 and 2007. Of 145 inpatients, 115 had capacity for medical decisions on admission. Of these, 49% participated in an end-of-life discussion during their hospital stay and 40% lost decision-making capacity before such discussions, requiring surrogates to speak on their behalf. In 13, no such conversations were documented during their hospitalizations. The patients for whom surrogates made decisions received significantly more life-prolonging treatments such as mechanical ventilation (57% vs. 23%), chemotherapy (39% vs. 5%), and artificial nutrition (46% vs. 25%).

Citation(s):

Zaros MC et al. Opportunity lost: End-of-life discussions in cancer patients who die in the hospital. J Hosp Med 2013 Jun; 8:334.