Melissa M Garrido1, Tracy A Balboni2, Paul K Maciejewski3, Yuhua Bao3, Holly G Prigerson4. 1. James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York, New York, USA. 2. Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA. 3. Weill Cornell Medical College, New York, New York, USA. 4. Weill Cornell Medical College, New York, New York, USA. Electronic address: hgp2001@med.cornell.edu.
Abstract
CONTEXT: Advance directives (ADs) are expected to improve patients' end-of-life outcomes, but retrospective analyses, surrogate recall of patients' preferences, and selection bias have hampered efforts to determine ADs' effects on patient outcomes. OBJECTIVES: The aim was to examine associations among ADs, quality of life, and estimated costs of care in the week before death. METHODS: We used prospective data from interviews of 336 patients with advanced cancer and their caregivers and analyzed patient baseline interview and caregiver and provider post-mortem evaluation data from the Coping with Cancer study. Cost estimates were from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and published Medicare payment rates and cost estimates. Outcomes were quality of life (range 0-10) and estimated costs of care received in the week before death. Because patient end-of-life care preferences influence both AD completion and care use, analyses were stratified by preferences regarding heroic end-of-life measures (everything possible to remain alive). RESULTS: Most patients did not want heroic measures (76%). Do-not-resuscitate (DNR) orders were associated with higher quality of life (β = 0.75, standard error = 0.30, P = 0.01) across the entire sample. There were no statistically significant relationships between DNR orders and outcomes among patients when we stratified by patient preference or between living wills/durable powers of attorney and outcomes in any of the patient groups. CONCLUSION: The associations between DNR orders and better quality of life in the week before death indicate that documenting preferences against resuscitation in medical orders may be beneficial to many patients.
CONTEXT: Advance directives (ADs) are expected to improve patients' end-of-life outcomes, but retrospective analyses, surrogate recall of patients' preferences, and selection bias have hampered efforts to determine ADs' effects on patient outcomes. OBJECTIVES: The aim was to examine associations among ADs, quality of life, and estimated costs of care in the week before death. METHODS: We used prospective data from interviews of 336 patients with advanced cancer and their caregivers and analyzed patient baseline interview and caregiver and provider post-mortem evaluation data from the Coping with Cancer study. Cost estimates were from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and published Medicare payment rates and cost estimates. Outcomes were quality of life (range 0-10) and estimated costs of care received in the week before death. Because patient end-of-life care preferences influence both AD completion and care use, analyses were stratified by preferences regarding heroic end-of-life measures (everything possible to remain alive). RESULTS: Most patients did not want heroic measures (76%). Do-not-resuscitate (DNR) orders were associated with higher quality of life (β = 0.75, standard error = 0.30, P = 0.01) across the entire sample. There were no statistically significant relationships between DNR orders and outcomes among patients when we stratified by patient preference or between living wills/durable powers of attorney and outcomes in any of the patient groups. CONCLUSION: The associations between DNR orders and better quality of life in the week before death indicate that documenting preferences against resuscitation in medical orders may be beneficial to many patients.
Authors: Thanh N Huynh; Eric C Kleerup; Joshua F Wiley; Terrance D Savitsky; Diana Guse; Bryan J Garber; Neil S Wenger Journal: JAMA Intern Med Date: 2013-11-11 Impact factor: 21.873
Authors: Caroline J Wilson; Jeffrey Newman; Sharon Tapper; Steve Lai; Peter H Cheng; Frances M Wu; Ming Tai-Seale Journal: J Palliat Med Date: 2013-06-06 Impact factor: 2.947
Authors: Benjamin Chastek; Carolyn Harley; Joel Kallich; Lee Newcomer; Carly J Paoli; April H Teitelbaum Journal: J Oncol Pract Date: 2012-07-03 Impact factor: 3.840
Authors: Kara E Bischoff; Rebecca Sudore; Yinghui Miao; Walter John Boscardin; Alexander K Smith Journal: J Am Geriatr Soc Date: 2013-01-25 Impact factor: 5.562
Authors: Benjamin Margolis; Ling Chen; Melissa K Accordino; Grace Clarke Hillyer; June Y Hou; Ana I Tergas; William M Burke; Alfred I Neugut; Cande V Ananth; Dawn L Hershman; Jason D Wright Journal: Am J Obstet Gynecol Date: 2017-07-11 Impact factor: 8.661
Authors: Lissi Hansen; Karen S Lyons; Nathan F Dieckmann; Michael F Chang; Shirin Hiatt; Emma Solanki; Christopher S Lee Journal: Res Nurs Health Date: 2017-06-30 Impact factor: 2.228
Authors: Jessica Ma; Stephen Chi; Benjamin Buettner; Katherine Pollard; Monica Muir; Charu Kolekar; Noor Al-Hammadi; Ling Chen; Marin Kollef; Maria Dans Journal: Crit Care Med Date: 2019-12 Impact factor: 7.598
Authors: Meagan E Cea; M Cary Reid; Charles Inturrisi; Lisa R Witkin; Holly G Prigerson; Yuhua Bao Journal: J Pain Symptom Manage Date: 2016-09-29 Impact factor: 3.612