Opportunity lost: End-of-life discussions in cancer patients who die in the hospital

BACKGROUND End‐of‐life discussions are associated with decreased use of life‐sustaining treatments in patients dying of cancer in the outpatient setting, but little is known about discussions that take place during terminal hospitalizations. OBJECTIVES To determine the proportion of patients assessed by the clinical team to have decisional capacity on admission, how many of these patients participated or had a surrogate participate in a discussion about end‐of‐life care, and whether patient participation was associated with treatments received. DESIGN Retrospective review. SETTING Inpatient. PATIENTS Adult patients with advanced cancer who died in the hospital between January 1, 2004 and December 31, 2007. RESULTS Of the 145 inpatients meeting inclusion criteria, 115 patients (79%) were documented to have decisional capacity on admission. Among these patients, 46 (40%) were documented to lose decisional capacity prior to an end‐of‐life discussion and had the discussion held instead by a surrogate. Patients who had surrogate participation in the end‐of‐life discussions were more likely to receive mechanical ventilation (56.5% vs 23.2%, P < 0.01), artificial nutrition (45.7% vs 25.0%, P = 0.03), chemotherapy (39.1% vs 5.4%, P