Table. Characteristics of Patients Who Completed 3 Key Steps in the EOLOA Process.
| Characteristic | No. (%) | ||
|---|---|---|---|
| Completed First Oral
Request (n = 176) |
Prescribed EOLOA
Drugs (n = 108) |
Ingested EOLOA
Drugs (n = 68) |
|
| Age at time of death, median (IQR), y | 69 (62-79) | 69 (62-79) | 69 (62-80) |
| 18-34 | 2 (1) | 0 | 0 |
| 35-54 | 11 (6) | 7 (6) | 4 (6) |
| 55-64 | 46 (26) | 31 (29) | 22 (32) |
| 65-74 | 49 (28) | 30 (28) | 17 (25) |
| 75-84 | 45 (26) | 25 (23) | 14 (21) |
| ≥85 | 23 (13) | 15 (14) | 11 (16) |
| Sex | |||
| Male | 99 (56) | 61 (56) | 39 (57) |
| Female | 77 (44) | 47 (44) | 29 (43) |
| Race | |||
| White | 141 (80) | 88 (81) | 52 (76) |
| Hispanic | 17 (10) | 9 (8) | 7 (10) |
| Black/African American | 1 (1) | 0 | 0 |
| American Indian/Alaska Native | 1 (1) | 1 (1) | 1 (1) |
| Asian | 13 (7) | 8 (7) | 7 (10) |
| Multirace | 1 (1) | 0 | 0 |
| Marital status | |||
| Married/partnered | 86 (49) | 56 (52) | 32 (47) |
| Unpartnered | 80 (45) | 46 (43) | 33 (49) |
| Missing | 10 (6) | 6 (6) | 3 (4) |
| Social support | |||
| Lives with others | 116 (66) | 69 (64) | 45 (66) |
| Patient informed family of EOLOA decision | 155 (88) | 100 (93) | 64 (94) |
| Education (census based) | |||
| <High school | 20 (11) | 12 (11) | 8 (12) |
| High school | 90 (51) | 55 (51) | 35 (51) |
| College | 64 (36) | 40 (37) | 26 (38) |
| Unknown | 2 (1) | 1 (1) | 0 |
| Income (census based), $ | |||
| <20 000 | 24 (14) | 14 (13) | 9 (13) |
| 20 000-49 999 | 40 (23) | 25 (23) | 15 (22) |
| 50 000-74 999 | 28 (16) | 17 (16) | 11 (16) |
| 75 000-149 999 | 51 (29) | 31 (29) | 20 (30) |
| ≥150 000 | 31 (18) | 20 (18) | 12 (17) |
| English speaking | 164 (93) | 102 (94) | 63 (93) |
| Insurance coverage | |||
| Medicare | 115 (65) | 69 (64) | 41 (60) |
| Medicaid | 5 (3) | 0 | 0 |
| Commercial | 41 (23) | 30 (28) | 23 (34) |
| Private pay/other | 14 (8) | 8 (7) | 4 (6) |
| Unknown | 1 (1) | 1 (1) | 0 |
| Clinical and functional characteristics | |||
| Disease burden | |||
| Charlson comorbidity index, mean (SD) | 9.3 (4.26) | 9.2 (4.46) | 9.4 (4.63) |
| Quartile 1 (0-6) | 44 (25) | 28 (26) | 18 (26) |
| Quartile 2 (7-9) | 44 (25) | 27 (25) | 17 (25) |
| Quartile 3 (10-12) | 50 (28) | 31 (29) | 17 (25) |
| Quartile 4 (≥13) | 36 (20) | 20 (19) | 15 (22) |
| Underlying terminal diagnosis | |||
| ALS | 9 (5) | 7 (6) | 5 (7) |
| Cancer | 130 (74) | 82 (76) | 52 (76) |
| Genitourinary | 23 (13) | 14 (13) | 11 (16) |
| Lung | 23 (13) | 13 (12) | 8 (12) |
| Gastrointestinal | 18 (10) | 9 (8) | 7 (10) |
| Head/neck | 18 (10) | 13 (12) | 7 (10) |
| Pancreas | 14 (8) | 10 (9) | 6 (9) |
| Breast | 11 (6) | 8 (7) | 4 (6) |
| Other | 23 (13) | 15 (14) | 9 (13) |
| CHF | 7 (4) | 4 (4) | 3 (4) |
| COPD/Other pulmonary conditions | 12 (7) | 6 (6) | 2 (3) |
| MS | 4 (2) | 3 (3) | 2 (3) |
| Parkinson | 3 (2) | 2 (2) | 0 |
| Other illnesses | 7 (4) | 3 (3) | 3 (4) |
| Unknown | 4 (2) | 1 (1) | 1 (1) |
| Functional status at time of inquirya | |||
| ADL Impairment | 96 (55) | 55 (51) | 37 (54) |
| Instrumental ADL impairment | 43 (24) | 23 (21) | 15 (22) |
| End-of-life concerns at time of inquiryb | |||
| Does not want to suffer | 110 (63) | 76 (70) | 45 (66) |
| Unable to enjoy daily activities | 97 (55) | 62 (57) | 40 (59) |
| Loss of autonomy | 36 (20) | 24 (22) | 10 (15) |
| Burden on family/friends | 38 (22) | 23 (21) | 16 (24) |
| Inadequate pain control or concern about it | 36 (20) | 23 (21) | 19 (28) |
| Loss of dignity | 24 (14) | 17 (16) | 14 (21) |
| Other (eg, financial concerns) | 16 (9) | 9 (8) | 6 (9) |
| Timing of EOLOA processes, median (IQR), days | |||
| Timing from inquiry to first oral request | 7 (3-14) | 7 (3-14) | 7 (2-13) |
| Timing from inquiry to second oral request | 26 (20-35) | 27 (20-38) | 24 (18-33) |
| Timing from first to second oral request | 17 (15-20) | 17 (15-21) | 16 (15-18) |
| Timing from prescription to ingestion/death | NA | NA | 9 (7-85) |
| Care near the end of life, median (IQR) | |||
| Primary care visits in 12 months prior to inquiry | 3 (2-8) | 3 (1-8) | 4 (2-8) |
| Specialist care visits in 12 months prior to inquiry | 13 (6-28) | 14 (6-29) | 14 (6-27) |
| Palliative care (outpatient or home-based) | |||
| At time of inquiry | 84 (48) | 55 (51) | 34 (50) |
| Ever | 109 (62) | 70 (65) | 43 (63) |
| Length of time since first exposure to PC services prior to inquiry, median (IQR), daysc | 92 (22-338) | 110 (28-391) | 103 (72-397) |
| Hospice care | |||
| At time of inquiry | 84 (48) | 52 (48) | 38 (56) |
| Ever | 139 (79) | 86 (80) | 59 (87) |
| Length of time on hospice prior to inquiry, median (IQR), daysc | 16 (5-60) | 16 (4-75) | 23 (4-65) |
| Advance care planning on record at inquiry | |||
| Advance directive | 108 (61) | 68 (63) | 43 (63) |
| POLST | 88 (50) | 53 (49) | 33 (49) |
| Code status at inquiry | |||
| Full code | 72 (41) | 42 (39) | 24 (35) |
| DNR | 73 (42) | 46 (43) | 32 (47) |
| Missing | 31 (18) | 20 (19) | 12 (18) |
| Death location | |||
| Home/home hospice | 170 (97) | 106 (98) | 68 (100) |
| Hospital/ED/SNF/other | 6 (3) | 2 (2) | 0 |
Abbreviations: ADL, activities of daily living; ALS, amyotrophic lateral sclerosis; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DNR, do not resuscitate; ED, emergency department; EOLOA, California End of Life Option Act; IQR, interquartile range; MS, multiple sclerosis; SNF, skilled nursing facility; POLST, provider orders for life-sustaining treatment.
a
For the 3 respective column categories, activities of daily living missing for 24 (14%), 11 (10%), and 6 (9%); instrumental ADL, missing for 35 (20%), 17 (16%), and 10 (15%).
b
Patients could endorse multiple reasons at the time of their initial inquiry and reasons could change during the EOLOA process but this was not captured in this analysis.
c
Length of palliative care or hospice service only for patients who received palliative care or hospice prior to inquiry.