D22 THE COURSE OF CRITICAL ILLNESS: ADMISSION TO FOLLOW-UP: Underutilization Of End Of Life Care Plans And Palliative Care Resources In Lung Cancer Patients Admitted To Intensive Care Units

Publication Title

Am J Respir Crit Care Med

Document Type

Conference Proceeding

Publication Date

5-24-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Rationale: Recent studies demonstrate that the rate of intensive care unit (ICU) admission for patients with lung cancer has increased over time, suggesting an escalation in the aggressiveness of ICU care for lung cancer patients. However, data pertaining to planned management strategies towards the end of life, both prior to and during ICU admission, remain scarce. We aimed to document the end of life care plan and utilization of palliative care resources in lung cancer patients who died within 30 days of admission to the ICU. Methods: We retrospectively reviewed patients, with an active lung cancer diagnosis and admission to the ICU within 30 days of death, from a community hospital network of 4 hospitals in Washington State between 01/2013 and 07/2016. Results: A total of 142 patients were identified, with a median age of 70 (interquartile range, IQR: 63-77) and a slight predominance of males (51%, n=72). More than half (54%, n=72) of the patients did not have an advance directive in the electronic medical record. On ICU admission, 61% (86/142) of patients had a ‘full code’ status, while 39% (56/142) had a ‘do not resuscitate (DNR)’ code status. Of those with a ‘full code’ status, 88% (76/86) were changed to DNR status within a median of 1 day (IQR: 0-4) of ICU admission. The median time from ICU admission to death was 5 days (IQR: 2-11). Overall, 32% (46/142) of patients received a palliative care consultation during the ICU admission, or during the same hospital admission (Table). A change in status to DNR was directed during the palliative care consult in 42% (11/26) of patients. In addition, 9% (13/142) of patients were actively receiving antineoplastic therapy in the ICU. Conclusion: More than half of the lung cancer patients admitted to the ICU within 30 days of death did not have a documented advance directive. The majority of patients were ‘full code’ on ICU admission with only 32% receiving a palliative care consultation during the same hospital admission. This data suggests that the majority of lung cancer patients do not have a preemptive end of life care plan, and available palliative care resources are not being fully utilized. Quality improvement interventions aimed at this vulnerable population may improve end of life care and appropriate utilization of both palliative care and ICU resources.

Clinical Institute

Cancer

Specialty

Oncology

Specialty

Palliative Care

Specialty

Pulmonary Medicine

DOI

10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A7098

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