Table 3.
Unadjusted Associations Between Characteristics of EOL Discussions and EOL Care Received
| Characteristic | No. of Patients | Chemotherapy Last 14 Days of Life |
Acute Care in Last 30 Days of Life |
ICU Care in Last 30 Days of Life |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yes (%) | OR | 95% CI | P | Yes (%) | OR | 95% CI | P | Yes (%) | OR | 95% CI | P | ||
| All patients | |||||||||||||
| No. | 1,231 | 16 | 40 | 6 | |||||||||
| Source of EOL discussion | < .001 | < .001 | < .001 | ||||||||||
| No discussion | 149 | 26 | Reference | 48 | Reference | 5 | Reference | ||||||
| MR only | 205 | 21 | 0.77 | 0.47 to 1.26 | 61 | 1.67 | 1.09 to 2.56 | 13 | 2.56 | 1.12 to 5.83 | |||
| Survey only | 288 | 15 | 0.50 | 0.30 to 0.81 | 27 | 0.40 | 0.26 to 0.60 | 2 | 0.38 | 0.13 to 1.10 | |||
| MR plus survey | 589 | 12 | 0.39 | 0.25 to 0.60 | 37 | 0.63 | 0.44 to 0.90 | 5 | 0.98 | 0.44 to 2.18 | |||
| Patients with EOL discussion documented in MRA | |||||||||||||
| No. | 794 | 14 | 43 | 7 | |||||||||
| Days between first discussion and death | < .001 | < .001 | .002 | ||||||||||
| ≤ 30 | 311 | 21 | Reference | 58 | Reference | 12 | Reference | ||||||
| 31-60 | 186 | 10 | 0.40 | 0.23 to 0.69 | 41 | 0.51 | 0.35 to 0.73 | 5 | 0.43 | 0.21 to 0.90 | |||
| 61-90 | 108 | 8 | 0.34 | 0.16 to 0.70 | 32 | 0.34 | 0.22 to 0.55 | 6 | 0.45 | 0.18 to 1.10 | |||
| > 90 | 189 | 12 | 0.49 | 0.29 to 0.82 | 26 | 0.26 | 0.17 to 0.38 | 3 | 0.21 | 0.08 to 0.54 | |||
| Medical oncologist present at first discussion | .008 | .52 | .003 | ||||||||||
| No | 476 | 12 | Reference | 44 | Reference | 9 | Reference | ||||||
| Yes | 318 | 19 | 1.71 | 1.15 to 2.54 | 42 | 0.91 | 0.68 to 1.21 | 4 | 0.38 | 0.20 to 0.72 | |||
| Inpatient at first discussion | .02 | < .001 | .008 | ||||||||||
| No | 373 | 11 | Reference | 28 | Reference | 5 | Reference | ||||||
| Yes | 421 | 17 | 1.65 | 1.10 to 2.49 | 57 | 3.48 | 2.58 to 4.68 | 10 | 2.20 | 1.22 to 3.95 | |||
| Characteristic | No. of Patients | Any Aggressive Care |
Any Hospice Care |
Hospice Care Within 7 Days of Death (n = 718)* |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yes (%) | OR | 95% CI | P | Yes (%) | OR | 95% CI | P | Yes (%) | OR | 95% CI | P | ||
| All patients | |||||||||||||
| No. | 1,231 | 47 | 58 | 15 | |||||||||
| Source of EOL discussion | < .001 | < .001 | < .001 | ||||||||||
| No discussion | 149 | 59 | Reference | 20 | Reference | 17 | Reference | ||||||
| MR only | 205 | 67 | 1.40 | 0.90 to 2.16 | 29 | 1.64 | 0.99 to 2.71 | 40 | 3.33 | 1.12 to 9.92 | |||
| Survey only | 288 | 36 | 0.39 | 0.26 to 0.58 | 64 | 7.12 | 4.46 to 11.4 | 3 | 0.14 | 0.04 to 0.51 | |||
| MR plus survey | 589 | 43 | 0.51 | 0.36 to 0.74 | 75 | 12.0 | 7.74 to 18.7 | 16 | 0.99 | 0.37 to 2.66 | |||
| Patients with EOL discussion documented in MRA | |||||||||||||
| No. | 794 | 49 | 63 | 12 | |||||||||
| Days between first discussion and death | < .001 | < .001 | < .001 | ||||||||||
| ≤ 30 | 311 | 65 | Reference | 49 | Reference | 36 | Reference | ||||||
| 31-60 | 186 | 45 | 0.44 | 0.30 to 0.64 | 68 | 2.28 | 1.56 to 3.34 | 9 | 0.18 | 0.09 to 0.36 | |||
| 61-90 | 108 | 37 | 0.32 | 0.20 to 0.51 | 74 | 3.03 | 1.87 to 4.91 | 13 | 0.25 | 0.12 to 0.52 | |||
| > 90 | 189 | 34 | 0.28 | 0.19 to 0.41 | 77 | 3.49 | 2.33 to 5.23 | 14 | 0.28 | 0.16 to 0.50 | |||
| Medical oncologist present at first discussion | .71 | .005 | .09 | ||||||||||
| No | 476 | 48 | Reference | 59 | Reference | 17 | Reference | ||||||
| Yes | 318 | 50 | 1.06 | 0.80 to 1.40 | 69 | 1.53 | 1.13 to 2.07 | 23 | 1.48 | 0.95 to 2.30 | |||
| Inpatient at first discussion | < .001 | .001 | .004 | ||||||||||
| No | 373 | 35 | Reference | 69 | Reference | 14 | Reference | ||||||
| Yes | 421 | 62 | 3.02 | 2.26 to 4.04 | 58 | 0.62 | 0.46 to 0.83 | 24 | 1.94 | 1.23 to 3.05 | |||
Abbreviations: EOL, end of life; ICU, intensive care unit; MR, medical record; MRA, medical record abstraction; OR, odds ratio.
*
For the subgroup of 718 patients who received hospice.