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. 2014 Nov;135(2):244-8.
doi: 10.1016/j.ygyno.2014.08.039. Epub 2014 Sep 2.

Missed opportunities: Patterns of medical care and hospice utilization among ovarian cancer patients

Alaina J Brown  1 , Charlotte C Sun  1 , Lauren S Prescott  1 , Jolyn S Taylor  1 , Lois M Ramondetta  1 , Diane C Bodurka  1
Affiliations

Missed opportunities: Patterns of medical care and hospice utilization among ovarian cancer patients

Alaina J Brown et al. Gynecol Oncol. 2014 Nov.

Abstract

Objectives: To assess aggressive medical care, hospice utilization, and advance care documentation among ovarian cancer patients in the final thirty days of life.

Methods: Ovarian, fallopian tube, or primary peritoneal cancer patients registered at our institution during 2007-2011 were identified. Statistical analyses included Wilcoxon-Mann-Whitney, Chi-square analysis, and multivariate analysis.

Results: 183 patients met inclusion criteria. Median age at diagnosis was 58. Most were white and had advanced ovarian cancer. Fifty percent had experienced at least one form of aggressive care during the last 30days of life. Patients with provider recommendations to enroll in hospice were more likely to do so (OR 27.7, p=<0.001), with a median hospice stay of 18days before death. Seventy-five percent had an in-hospital DNR order and 33% had an out-of-hospital DNR order. These orders were created a median of 15 and 12days prior to death, respectively. Twenty-eight percent had a Medical Power of Attorney and 20% had a Living Will. These documents were created a median of 381 and 378days prior to death, respectively.

Conclusions: Many ovarian cancer patients underwent some form of aggressive medical care in the last 30days of life. The time between hospice enrollment and death was short. Patients created Medical Power of Attorney and Living Will documents far in advance of death. DNR orders were initiated close to death.

Keywords: Advance directives; End-of-life care; Ovarian cancer.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Percentage of patients receiving markers of aggressive medical care at the end of life *DOL = days of life
Figure 2
Figure 2
Percentage of patients receiving palliative care consults prior to death *Among those patients receiving a Palliative Care consult ** Defined as Palliative Care consult within the last 30 days of life
Figure 3
Figure 3
Location of death *3 patients originally enrolled in hospice care were ultimately admitted and died in the hospital **Percentile calculated based on all patients in the study
Figure 4
Figure 4
Percentage of patients with advance care planning documents
See this image and copyright information in PMC

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