dc.contributor.author | Wright, Alexi | |
dc.contributor.author | Zhang, Baohui | |
dc.contributor.author | Ray, Alaka | |
dc.contributor.author | Mack, Jennifer | |
dc.contributor.author | Trice, Elizabeth | |
dc.contributor.author | Balboni, Tracy | |
dc.contributor.author | Mitchell, Susan | |
dc.contributor.author | Jackson, Vicki | |
dc.contributor.author | Block, Susan | |
dc.contributor.author | Maciejewski, Paul | |
dc.contributor.author | Prigerson, Holly | |
dc.date.accessioned | 2021-09-09T16:07:21Z | |
dc.date.issued | 2008-10-08 | |
dc.identifier | Quick submit: 2015-07-04T11:24:45-04:00 | |
dc.identifier.citation | Wright, Alexi, Baohui Zhang, Alaka Ray, Jennifer Mack, Elizabeth Trice, Tracy Balboni, Susan Mitchell et al. "Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment." Journal of the American Medical Association 300, no. 14 (2008): 1665-1673. DOI: 10.1001/jama.300.14.1665 | |
dc.identifier.issn | 0098-7484 | en_US |
dc.identifier.issn | 1538-3598 | en_US |
dc.identifier.uri | https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37369356 | * |
dc.description.abstract | Context
Talking about death can be difficult. Without evidence that end-of-life (EOL) discussions improve patient outcomes, physicians must balance their desire to honor patient autonomy against a concern that EOL discussions may inflict psychological harm.
Objective
To determine whether EOL discussions with physicians are associated with fewer aggressive interventions.
Design, Setting, Participants
A United States multi-site, prospective, longitudinal cohort study of advanced cancer patients and their informal caregivers (n=332 dyads), September 2002-February 2008. Patients were followed from enrollment to death a median of 4.4 months later. Bereaved caregivers’ psychiatric illness and quality of life (QoL) was assessed a median 6.5 months later.
Main Outcome Measures
The primary outcome were aggressive medical care (e.g., ventilation, resuscitation) and hospice in the final week of life. Secondary outcomes included patients’ mental health and caregivers’ bereavement adjustment.
Results
123 of 332 (37.0%) patients reported EOL discussions before baseline. EOL discussions were not associated with higher rates of Major Depressive Disorder (8.3% vs. 5.8; AOR 1.33, 95% CI 0.54-3.32), or more “worry” (6.5 vs. 7.0; p=0.19)). After propensity-score weighted adjustment, EOL discussions were associated with lower rates of ventilation (1.6% vs. 11.0%; AOR 0.26, 95% CI 0.08-0.83), resuscitation (0.8% vs. 6.7%; AOR 0.16, 95% CI 0.03-0.80), ICU admission (4.1 vs. 12.4%; AOR 0.35, 95% CI 0.14-0.90), and earlier hospice enrollment (65.6% vs. 44.5%; AOR 1.58, 95% CI 1.04-2.63). In adjusted analyses, more aggressive medical care was associated with worse patient QoL (6.4 vs. 4.6; F=3.60, p=0.01) and higher risk for Major Depressive Disorder in bereaved caregivers (AOR 3.37, 95% CI 1.12-10.13), while longer hospice stays were associated with better patient QoL (5.6 vs. 6.9; F=3.70, p=0.01). Better patient QoL was associated with better caregiver QoL at follow-up (β=0.20; p=0.001).
Conclusion
EOL discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient QoL and worse bereavement adjustment. | en_US |
dc.language.iso | en_US | en_US |
dc.publisher | American Medical Association (AMA) | en_US |
dc.relation.isversionof | doi:10.1001/jama.300.14.1665 | en_US |
dc.relation.hasversion | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853806/ | en_US |
dash.license | META_ONLY | |
dc.title | Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment | en_US |
dc.type | Journal Article | en_US |
dc.date.updated | 2015-07-04T15:25:13Z | |
dc.description.version | Accepted Manuscript | en_US |
dc.rights.holder | Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG | |
dc.relation.journal | Journal of the American Medical Association | en_US |
dash.depositing.author | Balboni, Tracy | |
dc.date.available | 2021-09-09T16:07:21Z | |
dc.identifier.doi | 10.1001/jama.300.14.1665 | * |
dash.source.volume | 300 | en_US |
dash.source.page | 1665-1673 | en_US |
dash.source.issue | 14 | en_US |
dash.contributor.affiliated | Mack, Jennifer | |
dash.contributor.affiliated | Wright, Alexi | |
dash.contributor.affiliated | Mitchell, Susan | |
dash.contributor.affiliated | Jackson, Vicki | |
dash.contributor.affiliated | Ray, Alaka | |
dash.contributor.affiliated | Balboni, Tracy | |
dash.contributor.affiliated | Block, Susan | |