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Earlier planning needed to improve end of life outcomes

Among patients with cancer referred to hospice, advanced care planning documented in electronic health records was tied to significantly fewer hospital admissions within the last 30 days of life, according to a study published in the American Journal of Hospice & Palliative Medicine.

Although an advanced care planning (ACP) note completed 30 days before death was associated with lower odds of hospital admission in the last 30 days of life, patients with an ACP note 6 months before death had even lower odds, suggesting that earlier planning provides better end-of-life outcomes.

“Patients with cancer and caregivers often view hospice admissions as marking the loss of hope of recovery, accompanied by deep grief and a sense of loss,” Laura C. Prater, PhD, MPH, MHA, of the department of general internal medicine in the Ohio State University Wexner Medical Center, and colleagues wrote. “However, prior research has shown that those with terminal illness who died in hospice had better outcomes at the [end of life] such as increased quality of life, better patient experience, and reduced likelihood of intensive care unit (ICU) admissions and hospital mortality, relative to those who died in an institutional setting.”

Researchers conducted a retrospective cohort study with EHR data for patients with cancer who were referred to hospice between Jan. 1, 2014, and Dec. 31, 2015, to determine if end-of-life planning was associated with hospital admission in the last 30 days of life.

Patients with treatment measures on the EHR made 1 year to 30 days before death were included in the study. Treatment measures, which indicated different types of ACPs, evaluated in the study were: an ACP note in the problem list of the EHR, a scanned advanced directive such as a living will or health care power of attorney and a verified do not resuscitate order.

The study included 1,185 patients with cancer who were referred to hospice.

Researchers found that patients with a do not resuscitate order verified before the last 30 days of life had lower odds of hospital admission during the last 30 days of life compared with those who did not (OR = 0.3; 95% CI, 0.21-0.41).

Compared with patients without an ACP note in the EHR, patients who had an ACP note completed 30 days before death had lower odds of being admitted to the hospital in the last 30 days of life (OR = 0.71; 95% CI, 0.51-0.88). The odds were even lower if the patient had an ACP note established 6 months before death (OR = 0.35; 95% CI, 0.22-0.55) compared with patients who did not have an ACP note.

Advanced directives were not significantly associated with lower odds of hospital admission within 30 days of death.

Researchers noted that interventions that target early and consistent EHR-based ACP could provide a relatively low-cost and effective solution to improving outcomes in cancer patients at the end of life.

“Our research supports the importance of sharing your wishes with your physician and your family, and suggests that doing that earlier can prevent unwanted procedures and hospitalizations that don’t align with your priorities and deteriorate your quality of life,” Prater said in a press release. – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.