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End-of-Life Preferences, Length-of-Life Conversations, and Hospice Enrollment in Palliative Care: A Direct Observation Cohort Study among People with Advanced Cancer.
Gramling, Robert; Ingersoll, Luke T; Anderson, Wendy; Priest, Jeff; Berns, Stephen; Cheung, Katharine; Norton, Sally A; Alexander, Stewart C.
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  • Gramling R; 1 Department of Family Medicine, Division of Palliative Medicine, University of Vermont Medical Center, Burlington, Vermont.
  • Ingersoll LT; 2 Department of Consumer Science, Purdue University, West Lafayette, Indiana.
  • Anderson W; 3 Department of Medicine, University of California, San Francisco, San Francisco, California.
  • Priest J; 4 Medical Biostatistics Unit, University of Vermont, Burlington, Vermont.
  • Berns S; 5 Department of Family Medicine, University of Vermont, Burlington, Vermont.
  • Cheung K; 6 Department of Medicine, University of Vermont, Burlington, Vermont.
  • Norton SA; 7 School of Nursing, University of Rochester, Rochester, New York.
  • Alexander SC; 2 Department of Consumer Science, Purdue University, West Lafayette, Indiana.
J Palliat Med ; 22(2): 152-156, 2019 02.
Article en En | MEDLINE | ID: mdl-30526222
CONTEXT: Prognosis communication is one hypothesized mechanism by which effective palliative care (PC) promotes preference-concordant treatment near end of life (EOL), but little is known about this relationship. METHODS: This is a multisite cohort study of 231 hospitalized patients with advanced cancer who consulted with PC. We audio-recorded the initial consultation with the PC team and coded conversations for all statements regarding expectations for how long the patient will live. We refer to these statements as length-of-life talk. We followed patients for up to six months to determine EOL treatment utilization, including hospice enrollment. Patients completed a brief interviewer-facilitated questionnaire at study enrollment. RESULTS: Forty-four percent (101/231) of observed conversations contained at least one statement about expectations for length of life, and 60% of patients (139/231) enrolled in hospice during the six months following these conversations. The association between length-of-life talk and hospice enrollment was strong among those (155/231) who endorsed treatment preferences favoring comfort over longevity in the last weeks to months of life (odds ratio [OR]adj = 2.98; 95% confidence interval [CI] = 1.34-6.65) and weak/absent among others (69/231; ORadj = 0.70; 95% CI = 0.16-3.04). CONCLUSIONS: Talking about expectations for remaining length of life during PC consultations is associated with six-month hospice enrollment among people with advanced cancer who endorse preferences for EOL treatment that favor comfort over longevity.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Paliativos / Cuidado Terminal / Actitud Frente a la Muerte / Actitud Frente a la Salud / Enfermedad Crítica / Prioridad del Paciente / Neoplasias Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Patient_preference Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Paliativos / Cuidado Terminal / Actitud Frente a la Muerte / Actitud Frente a la Salud / Enfermedad Crítica / Prioridad del Paciente / Neoplasias Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Patient_preference Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos