Reducing Futile Acute Care Services for Terminally Ill Patients With Cancer: The Dignity Project

Salama, Hind; Mutairi, Nashmia Al; Damlaj, Moussab; Alolayan, Ashwaq; Binahmed, Ahmed; Salama, Hagir; Tlayjeh, Haytham; Alhejazi, Ayman; Lawrence, Myer; Shehata, Hussam; Shami, Mona Al; Alkaiyat, Mohammad; Jazieh, Abdul Rahman

doi:10.1200/op.20.00922

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Also reflected in the relevant literature are the varied patient populations and outcomes under study. Although some studies 13,37,40 examined EOL health care use metrics similar to those we investigated, others have demonstrated effects of GOC discussions on different outcomes of clinical pertinence, such as patient-centered communication, 41 caregiver bereavement adjustment and patient mental health, 19 and health care costs. 21 We acknowledge limitations of this study, in addition to those discussed previously.…”

Section: Discussionmentioning

confidence: 99%

Goals of care documentation by medical oncologists and oncology patient end‐of‐life care outcomes

Epstein

Riley

Nelson

et al. 2022

Cancer

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Background Goals of care (GOC) documentation is important but underused. We aimed to improve oncologist GOC documentation and end‐of‐life (EOL) care. Methods In April 2020, our cancer center launched a GOC note template, including optional fields for documenting discussion with the patient about: cancer natural history, goals, and/or EOL (resuscitation preferences, hospice receptivity). Associations between GOC notes and EOL care were evaluated. Results Among 1721 patients dying between June 1, 2020 and June 30, 2021, median days from first GOC note (± with documentation of EOL discussion) to death was 92, whereas a GOC note including EOL discussion (“GOC EOL note”), specifically, was 31. Patients with a first GOC note >60 days before death spent fewer days inpatient (6.7 vs 10.6 days, p < .001). Among patients with GOC EOL notes, those with such documentation >30 days before death had fewer inpatient (5 vs 11, p < .001) and intensive care unit days (0.5 vs 1.5, p < .001), more hospice referrals (57% vs 44%, p = .003), and less chemotherapy ≤14 days before death (6% vs 11%, p = .010). Of 925 admissions of patients dying within ≤30 days, those with GOC EOL notes were shorter (7 vs 9 days, p = .013) but not associated with more hospice discharge (30% vs 25%, p = .163). Oncologist (vs nononcologist) GOC documentation and earlier documentation of EOL discussion were associated in subset analyses with less inpatient care and more hospice referrals. Conclusions Documentation of GOC, including EOL discussions, is associated with favorable performance on accepted indicators of quality EOL care.

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Section: Discussionmentioning

confidence: 99%

Goals of care documentation by medical oncologists and oncology patient end‐of‐life care outcomes

Epstein

Riley

Nelson

et al. 2022

Cancer

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“…By being able to confidently lead GOC conversations, anesthesiologists provide patients with autonomy during a vulnerable time. In addition, current literature has demonstrated that engaging in perioperative GOC and advanced planning conversations are associated with improved patient outcomes and satisfaction, in addition to resulting in healthcare savings [21].…”

Section: Shared Decision-makingmentioning

confidence: 99%

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

Krishnan

Adeola

Urman

2022

Current Opinion in Anaesthesiology

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Purpose of reviewPreoperative clinics and patient optimization are examples of collaborative, multidisciplinary care pathways that create value. This article reviews current literature to demonstrate the importance of preoperative enhancement of patients’ cognitive and functional status. This article underscores the importance of formal training in multidisciplinary topics, such as frailty, brain health, and shared decision-making for anesthesiology house staff.Recent findingsPreoperative cognitive screening of older patients is a valuable metric for risk stratification and detection of patients at risk of postoperative delirium. Frailty is another syndrome that can be identified and optimized preoperatively. Sarcopenia has been shown to correlate with frailty; this shows promise as a method to detect frailty preoperatively.SummaryAnesthesiologists as perioperative physicians are in a unique position to lead and coordinate interdisciplinary conversations that incorporate patient goal concordant care and realistic assessment of perioperative complications. Formal house staff training in early recognition and management of patients at risk of adverse outcomes in the short and long term postoperatively improves patient outcomes and decreases healthcare spending.

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“…Several multidisciplinary projects such as The Dignity Project have focused on refining communication styles to include families in goals of care decision making without violating a patient's autonomy. 14 …”

Section: Introductionmentioning

confidence: 99%

Preferences and Attitudes of Cardiologists in Management of Patients with Cancer

Azar

Wang

Dhillon

et al. 2022

Palliative Medicine Reports

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Background: With recent improvements in survival of cancer patients and common use of high-value care at end of life, the management of cardiovascular disease (CVD) in patients with cancer is increasingly important. To our knowledge, there are no current U.S. data examining how the presence and extent of cancer influence cardiologists' decision making for common cardiovascular conditions. Methods: An anonymous online vignette-based survey of cardiologists was conducted at five U.S. institutions investigating how the extent of gastrointestinal and thoracic malignancies (prior/localized, metastatic) would influence treatment recommendations for atrial fibrillation (AF), aortic stenosis, unstable angina (UA), and obstructive coronary artery disease (CAD). Results: Thirty-three percent (86/259) of cardiologists completed the survey between September and November 2019. Participants were 67% male, 51% below age 40, and 58% had five or more years of clinical experience. Majority of cardiologists practiced at teaching hospitals (72%) and were noninterventional (63%). Cardiologists were more likely to recommend procedural interventions for patients with localized cancer than for those with metastatic disease: AF (left atrial appendage occlusion: 20% vs. 8%), atrial stenosis (aortic valve repair: 83% vs. 11%), UA (left heart catheter: 70% vs. 27%), and obstructive CAD (percutaneous coronary intervention: 81% vs. 38%). In patients with metastatic cancer, most cardiologists sought an oncology (82%) or a palliative care (69%) consultation. However, a persistent trend of undertreatment in patients with localized cancers and overtreatment in patients with end-of-life disease was apparent. Conclusions: Cardiologists were less likely to recommend invasive cardiovascular therapies to patients with metastatic cancer. This preference pattern likely reflects the influence of comorbidities and quality of life expectation on cardiologists' treatment recommendations but may also be related to the stigma of advanced cancer. Better communication between cardiologists and oncologists is necessary to provide a personalized care of patients with cancer and CVD that would maximize treatment benefit with least morbidity.

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Reducing Futile Acute Care Services for Terminally Ill Patients With Cancer: The Dignity Project

Cited by 7 publications

References 17 publications

Goals of care documentation by medical oncologists and oncology patient end‐of‐life care outcomes

Goals of care documentation by medical oncologists and oncology patient end‐of‐life care outcomes

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

Preferences and Attitudes of Cardiologists in Management of Patients with Cancer

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