Documentation of Information and Care Planning for Patients with Advanced Cancer

Abstract

Objective: We evaluated the association between patient characteristics, utilization of care, and documentation of information and care planning. Methods: We abstracted chart documentation for 238 deceased patients with advanced cancer. Results: Do-not-resuscitate (DNR) orders were documented in 34% of charts, advance directives in 19%, hospice discussion in 49%, and hospice referral in 36%. Compared to white patients, black patients had a higher odds of hospice discussion (Adjusted Odds Ratio [AOR] 2.11; 95% CI 1.18 to 3.76) and hospice referral (AOR 2.18; 95% CI 1.21 to 3.93). Documentation of advance directive and DNR order was associated with higher utilization of care. Conclusion: Black race was associated with higher odds of hospice discussion and referral in a primarily Medicaid population. Additional research is needed to explore variations in physician–patient discussion about hospice among different patient populations.