Cancer patients who engage in advance care planning are more likely to receive less aggressive, more comfort-based end-of-life care when compared to their peers who do not have an advanced care plan in place, a new study finds.

Researchers from the Regenstrief Institute and the Indiana University School of Nursing performed a meta-analysis of studies involving more than 33,000 cancer patients.

Fewer intensive care admissions

Advance care planning was associated with significantly lower odds of care indicators that can be considered aggressive at the end-of-life stage, they reported. This included chemotherapy, intensive care, hospital admissions, delayed hospice referrals and death in the hospital. 

What’s more, cancer patients who are engaged in advance care planning are 50% more likely to complete “do not resuscitate” orders than those who were not, the authors found. 

Other outcomes were not affected by participation in advance care planning. These included hospice use, cardiopulmonary resuscitation, emergency department admissions and mechanical ventilation.

Cancer patients often have a protracted chronic illness with fairly high levels of functioning that don’t decline steeply until the last six months of life. This gives many patients time to prepare, the researchers noted.

A positive impact

Advance care planning helps patients to prepare for this decision-making and ensure that end-of-life care is consistent with their preferences. It should be a dynamic process throughout the disease process, the researchers said.

“Advance care planning works in this illness population,” Kristin Levoy, PhD, MSN, RN, said in a statement. “We found it positively impacted the decision of patients and caregivers facing cancer to avoid hospital and intensive care unit admissions and to complete do not resuscitate orders at the end-of-life.”

Full findings were published in the Journal of Pain and Symptom Management.

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