The involvement of a palliative care team improved the use of advanced directives (AD) and goals of care (GOC) discussions and documentation among a group of veterans with cancer, according to a study published in Clinical Journal of Oncology Nursing.
“Little is known about factors that may contribute to advance directive and code status decisions among the veteran population,” study researchers wrote. “There is a limited knowledge base about demographic, disease-related, and social factors that may influence AD discussions among veterans with malignancy.”
To explore this area more, the researchers conducted a retrospective chart analysis to examine advance care planning and GOC among veterans with cancer. The study included data from 88 patients: half of the patients were White, 42 were Black, 1 was Latino, and 1 was Native American/Pacific Islander.
The most common primary cancers were lung (26 patients) and prostate (26 patients) cancers. The majority of patients said that a GOC discussion led to palliative care consultation.
After the initial palliative care discussion, 40 participants elected to have a DNR order. By the end of the study, 53 participants seen for palliative care consultation had a documented DNR.
Average time from initial diagnosis to palliative care referral was 31 months. More than half of the patients were referred to palliative care within 1 year of diagnosis. Most had documented metastatic disease at the time of the palliative care referral.
Veterans with prostate cancer were more likely to elect full code status compared with those with lung or other cancers. Those who elected DNR status had a more recent diagnosis than those who elected full code.
There was no difference in age, marital status, or combat history for those who elected DNR and those who remained full code. White veterans were more likely to choose a DNR order than Black veterans.
These results “emphasize the importance of honest and candid advanced care planning discussions between patients and clinicians that include accurate information about patient prognosis.”
Advance care planning and goals-of-care decisions among veterans with malignancy.