Advance Directives and Do-Not-Resuscitate Orders in Patients with Cancer with Metastatic Spinal Cord Compression: Advanced Care Planning Implications

JOURNAL OF PALLIATIVE MEDICINE, 2010 · DOI: 10.1089=jpm.2009.0376 · Published: May 1, 2010

Simple Explanation

The study investigates the presence of advance directives and DNR orders in patients with metastatic spinal cord compression (MSCC). MSCC patients have a short survival time, but little is known about their end-of-life care planning. The findings suggest that many MSCC patients may not be aware of the urgency to have an advance directive. This indicates a potential delay in end-of-life palliative care and suboptimal communication between doctors and patients. The diagnosis of MSCC can serve as a trigger for communication and initiation of palliative care. This approach may benefit both patients and their families by allowing them to prepare for end-of-life decisions.

Study Duration

3 years

Participants

88 consecutive patients with cancer who had MSCC

Evidence Level

Retrospective study

Key Findings

1
Only 23% of patients had a living will, 31% had health care proxies, and 11% had either out-of-hospital DNR order and=or dictated DNR note.
2
The median survival time for these patients was 4.3 months.
3
Among patients who died, the median time from the physician-dictated DNR note to the date of death was 16.5 days.

Research Summary

This retrospective study assessed the frequency of advance directives and DNR orders in 88 patients with MSCC requiring rehabilitation consultation. The study found low rates of advance care planning despite the short median survival time of these patients. The results suggest a need for improved doctor-patient communication regarding end-of-life goals of care in this patient population. The diagnosis of MSCC may serve as a trigger for initiating these important conversations. The study also observed trends suggesting that African Americans/blacks and Hispanics/Latinos had lower advance care planning rates, although these differences were not statistically significant, potentially due to the limited sample size.

Practical Implications

Improve Doctor-Patient Communication

Emphasize the need for doctors to proactively discuss end-of-life care with MSCC patients due to their short survival times.

Utilize MSCC as a Trigger

Use the diagnosis of MSCC as an opportunity to initiate advance care planning discussions and palliative care.

Address Disparities in Advance Care Planning

Further investigate and address the reasons behind lower advance care planning rates among African Americans/blacks and Hispanics/Latinos.

Study Limitations

1
Selection bias due to the study being conducted at a comprehensive cancer center may limit the generalizability of the findings.
2
The study had a limited sample size, which may have prevented the identification of statistically significant differences in advance care planning rates among certain patient groups.
3
The study only reviewed data from a single institution.

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