Unmet Quality Indicators of Care for Metastatic Cancer Patients Admitted to ICU in Last 2 Weeks of Life (S710)

Abstract

1.Understand the current quality of end-of-life care provided to patients with advanced cancer admitted to the ICU at our academic medical center.2.Discuss mechanisms to improve end-of-life care for patients with advanced cancer.3.Evaluate what barriers prevented palliative care consultation to significantly improve the quality of end-of-life care metastatic cancer patients receive. Evidence indicates that terminally ill cancer patients are subjected to ineffective treatments and do not receive quality care at the end of life. We wanted to gain a better understanding of the quality of end of life care (EOLC) received by terminally ill cancer patients admitted to the Intensive Care Unit (ICU) in the last 2 weeks of life. The established UK Quality Indicators were used to evaluate quality of care. Design: A retrospective chart review of the electronic medical records (EMR) of patients admitted to the ICU from January-August 2011 was completed. Six UK quality indicators (prognostication, advanced care planning, goals of care, caregiver needs, coordinated care across organizational boundaries, and standardized care pathway implementation) were used to assess quality of EOLC. Setting: Tertiary academic medical center with 663 beds and 66 adult ICU beds in Northern California, USA. Patients: 2498 patients were admitted to the ICU, 232 died within two weeks of admission; 69 of these patients died of metastatic cancer. 58% patients were male; average age 59.8 years (range 25-91). Quality indicators were met in a relatively small percentage of patients (prognostication 67%, advanced care planning 32%, goals of care 42%, caregiver needs 0%, coordination of care across organizational boundaries 7%, standardized care pathway implementation 58%) admitted to the ICU in the last 2 weeks of life. Palliative care consultations occurred in 28 of the 69 patients and resulted in increased POLST documentation. Quality indicators for EOLC were not met for majority of patients with advanced cancer admitted to the ICU. Earlier discussions with patients and families regarding their goals of care and preferred venue of death may help improve quality of care at EOL.