Dying Trajectory in the Last Year of Life: Does Cancer Trajectory Fit Other Diseases?

Teno, Joan M.; Weitzen, Sherry; Fennell, Mary L.; Mor, Vincent

doi:10.1089/109662101753381593

Cited by 259 publications

(204 citation statements)

References 16 publications

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“…The illness trajectory of patients dying with CKD differs from that of patients with cancer (12)(13)(14). There are also unique end-of-life issues, such as the withdrawal of dialysis, that are specific to these patients.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Care Preferences and Needs

Davison¹

2010

Clinical Journal of the American Society of Nephrology

538

545

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Background and objectives: Despite high mortality rates, surprisingly little research has been done to study chronic kidney disease (CKD) patients' preferences for end-of-life care. The objective of this study was to evaluate end-of-life care preferences of CKD patients to help identify gaps between current end-of-life care practice and patients' preferences and to help prioritize and guide future innovation in end-of-life care policy.Design, setting, participants, & measurements: A total of 584 stage 4 and stage 5 CKD patients were surveyed as they presented to dialysis, transplantation, or predialysis clinics in a Canadian, university-based renal program between January and April 2008.Results: Participants reported relying on the nephrology staff for extensive end-of-life care needs not currently systematically integrated into their renal care, such as pain and symptom management, advance care planning, and psychosocial and spiritual support. Participants also had poor self-reported knowledge of palliative care options and of their illness trajectory. A total of 61% of patients regretted their decision to start dialysis. More patients wanted to die at home (36.1%) or in an inpatient hospice (28.8%) compared with in a hospital (27.4%). Less than 10% of patients reported having had a discussion about end-of-life care issues with their nephrologist in the past 12 months.Conclusions: Current end-of-life clinical practices do not meet the needs of patients with advanced CKD.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Care Preferences and Needs

Davison¹

2010

Clinical Journal of the American Society of Nephrology

538

545

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“…40 Unlike many cancers, which are characterized by a steep linear decline in performance status during the last few months of life, heart failure is characterized by unpredictable decompensations and improvements, with a subtler decline over time. 41,42 This makes it difficult for doctors to recognize when it is appropriate to refer a patient to hospice. A sample algorithm for management of end-stage heart failure patients is found in Figure 2.…”

Section: Guideline Recommendations For Palliation In End-stage Heart mentioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

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H eart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure). 1 Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. In recognition of this, palliative/hospice care referral was recommended for endstage heart failure (Level of Evidence 1A) in the most recent American College of Cardiology/American Heart Association heart failure guidelines. 2 To identify evidence-based studies of palliative care in heart failure, we searched the Medline database for literature with the medical subject headings "heart failure" and "palliative care," "supportive care," or "symptom management" and found 394 results. We identified 92 systematic reviews, 44 of which were English-language systematic reviews published within the past 5 years.

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“…In general, cancer patients experience a marked decline in their physical function in their last 6 months of life-especially true in brain tumor patients-, associated with increased symptom severity. [13][14][15] In the case of cancer care, it is crucial to distinguish those who are:…”

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confidence: 99%