| Description |
End of life care is an essential part of the care of the patient. It not only is a continuation of the care of the patient we interact with as his or her disease gets worse, but also improves the quality of life for the patient's family once our patient passes away. Paladino, et al., (2019) state, "Earlier clinician-patient conversations about patients' values, goals, and preferences in serious illness (i.e ., serious illness conversations) are associated with better outcomes but occur inconsistently in cancer care". Fifty-five percent of cancer patients in one study were receiving palliative care but also inaccurately described their disease as curable (Yennurajalingam, et al., 2017). Our patients and their loved ones deserve open, honest, and clear communication. Patients who do not have a clear understanding of their prognosis may agree to aggressive treatment and also be subject to poor quality of life before their death.According to a study in the USA comparing cancer patients from 2006-2011, more of these patients are having ER visits and ICU admissions in the last 30 days of their lives and more patients are being discharged from the hospital to hospice care less than 3 days before their recorded deaths. The number of patients receiving chemotherapy in the last 14 days of their lives had not changed from 2006 to 2011 (Wang, et al., 2016). A study in Japan showed that for patients who had an end of life discussion with their doctors, after their death, their families had fewer chances of developing depression (Yamaguchi, et al., 2017). Another USA study found end of life discussions result in less aggressive medical interventions surrounding death as well as earlier hospice admissions. In addition, aggressive medical intervention is associated with worse quality of life for the patient and the bereaved (Wright, 2008). End of life care is recommended for all advanced terminal diseases, and there is no doubt how important this topic is for advanced cancer patients. It will be naïve to assume that cancer patients, who are being seen at cancer centers, are receiving appropriate attention in regards to end of life planning and conferences. End of life discussions should include expectations in response to therapies or progression of cancer, as well as having a plan for dying. If death is imminent, family members need to know where the patient would want to die, and when aggressive treatment should be stopped. It should also include a plan to have a surrogate decision-maker, who can make any medical decisions, in case the patient is unable to make them on their own (Wang, et al., 2016).Pontin & Jordan (2013), identify the difficulty physicians face in discussing prognosis with patients - most notably inaccuracy and over-optimism on the physician's part. One Australian study reported that, of the patients surveyed, only fourteen percent had recorded their end of life wishes and forty-five percent appointed a power of attorney. The crucial point is: those patients who believed their cancer as incurable were more open in end of life care planning (Waller, et al., 2018). The hypothesis: Patients with cancer, at a cancer hospital in the western United States, are not prepared for death and do not have adequate counseling about end of life planning. The goal of this quality improvement project is to improve communication between oncologists and patients. The intervention in this project is to measure if differing cancer clinic patients have prepared for their cancer getting worse, if they have asked or received appropriate responses to their end of life questions, and if they have appointed a health care proxy. |
