Documentation of code status at an outpatient academic cancer center: A marker of discussing end-of-life preferences.

Abstract

307 Background: Documentation of a patient’s code status preference is becoming an increasingly emphasized part of medical care. Hospitals are adopting protocols that encourage code status documentation at the time of admission; however, this requires patients to consider end of life care at a time of acute illness with a practitioner with whom they have little familiarity. We sought to assess the proportion of patients with a documented code status preference in the electronic medical records (EMR) of our outpatient oncology clinics. Methods: The EMR for all patients seen at the Abramson Cancer Center in the months of March, April, and May 2012 were reviewed for the presence of a documented code status and the specific code status designation. The query was limited to patients seen by a medical oncologist and to patients with at least five outpatient visits occurring during or prior to the month being studied. Demographic information regarding patient age, race, religion, medical comorbidities, and oncologic diagnosis including stage were also recorded. Results: A median of 2,071 patients who have had at least five prior visits were seen per month by staff medical oncologists. Of these patients, a median of 49 patients (2%) had a documented code status recorded in the EMR. Patients seen by the thoracic medical oncology group were more likely to have a documented code status (17% vs. <1%); however, these results were not statistically significant (p=0.3173), likely due to extremely small numbers of documentation. Given the low numbers of code status documentation, we were unable to detect an association with any other demographic factor. Conclusions: At our institution, only a small minority of patients with an oncologic diagnosis has documentation of code status in the readily available EMR. This initial analysis emphasizes the need for a larger effort targeted at increasing documentation of code status in the outpatient setting where patients have a longitudinal relationship with their care provider.