Discussions About End-of-life Care Planning Between Physicians and Patients with Stage IV Lung or Colorectal Cancer

Abstract 6026 Background: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with cancer patients whose life expectancy is less than one year. Previous studies typically rely on patient reports of discussions, even though patient and physician perceptions can differ, and usually as a one time assessment. We know little about the true incidence of EOL discussions or about where, when, or with whom they take place. METHODS: We evaluated EOL discussions among 2155 patients with stage IV lung or colorectal cancer enrolled in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system-based prospective cohort study. Discussions were reported in patient and surrogate surveys and in a comprehensive medical record abstraction over the first 15 months after diagnosis. Medical record data included the location, provider, and timing of discussions. RESULTS: 73% of patients had EOL discussions reported by patients or surrogates or documented in medical records. Among patients who died during the 15 month follow-up period (N=1524), 86% had EOL discussions, compared with 42% of patients who were alive at the end of follow-up (N=631). Among first EOL discussions documented in the medical record (N=1081), 55% occurred in the hospital and 45% in the outpatient setting. Medical record data included medical oncology visits for 85% of patients (median 6 visits), but oncologists documented EOL discussions with only 27% of their patients. Medical oncologists participated in 46% of EOL discussions for which provider specialty was known (N=860); other specialties were general medicine (34%), other medical specialties (14%), radiation oncology (4%), and surgery (3%). Of 983 patients who lived at least a month after diagnosis and died during follow up, 50% had a first documented EOL discussion before the last month of life, 32% during the last month of life, and 18% had no EOL discussions before death. CONCLUSIONS: Although most patients with stage IV lung or colorectal cancer have discussions with physicians about EOL care planning before death, many discussions occur in the setting of acute hospital care, with non-oncology providers, and late in the course of illness.