Abstract

BackgroundCommunication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decision making with Oncologists and Palliative care specialists) aimed to increase the rate of documentation on the preferences for DNR and ANH in patients with advanced cancer.MethodsThe SOP model was implemented in a national cancer treatment center in Taiwan from September 2016 to August 2018 for patients with advanced cancer visiting the oncology outpatient clinic. The framework was based on the model of shared decision making as “choice talk” initiated by oncologists with “option talk” and “decision talk” conducted by palliative care specialists.ResultsAmong 375 eligible patients, 255 patients (68%) participated in the model testing with the mean age of 68.5 ± 14.7 years (mean ± SD). Comparing to 52.3% of DNR documentation among patients with advanced cancer who died in our hospital, the rate increased to 80.9% (206/255) after the decision talk in our model. Only 6.67% (n = 17) of the participants documented their preferences on ANH after the model. A worse Eastern Cooperative Oncology Group Performance Status was the only statistically significant associating factor with a higher rate of DNR documentation in the multiple logistic regression model.ConclusionsThe SOP model significantly increased the rate of DNR documentation in patients with advanced cancer in this pilot study. Dissemination of the model could help the patients to receive care that is concordant with their wishes and be useful for the countries having laws on ACP.

Highlights

  • Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes

  • Several attempts from oncologists including using electronic prompts to remind oncologist for ACP, creating new workflows to incorporate ACP into routines in oncology outpatient clinics, or using semi-structured discussion are implemented to increase the documentation of code status and the rate have been elevated to about 60–70% [20,21,22]

  • The DNR documentation rate after implementing the SOP model increased from 44.3% (n = 113) after the option talk to 80.9% (n = 206) after the decision talk

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Summary

Introduction

Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decision making with Oncologists and Palliative care specialists) aimed to increase the rate of documentation on the preferences for DNR and ANH in patients with advanced cancer. Advance care planning (ACP) is a process of open discussion on topics including the assignment of a medical durable power of attorney, living wills, personal values and preferences for end-of-life (EOL) care which is essential for patients to honor their autonomy in future medical decisions [1]. Several attempts from oncologists including using electronic prompts to remind oncologist for ACP, creating new workflows to incorporate ACP into routines in oncology outpatient clinics, or using semi-structured discussion are implemented to increase the documentation of code status and the rate have been elevated to about 60–70% [20,21,22]

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