Objectives To assess aggressive medical care hospice utilization and advance care documentation among ovarian cancer patients in the final thirty days of life. with provider recommendations to enroll in hospice were more likely to do so (OR 27.7 p=<0.001) with a median hospice stay of 18 days before death. Seventy-five percent had an in-hospital DNR and 33% had an out-of-hospital DNR order. These orders were created a median of 15 and 12 days prior to death respectively. Twenty-eight percent had a Medical Power of Attorney and 20% had a Living Will. These documents were created a median of 381 and 378 days prior to death respectively. Ki16198 Conclusions Many ovarian cancer patients underwent some form of aggressive medical care in the last 30 days of life. The time between hospice enrollment and death was short. Patients created Medical Power of Attorney and Living Will documents far in advance of death. DNR orders were initiated close to Ki16198 death. INTRODUCTION Early discussions regarding the patient’s treatment goals and need for palliative supportive care may be perceived as premature by some. However early palliative care interventions provide advanced cancer patients with improved quality of life (QOL) regardless of whether or not they are receiving anti-cancer treatment (1 2 As a result both the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend that providers engage in discussions regarding advanced cancer patient’s treatment goals expectations and need for palliative care interventions early in the disease process (3 4 These advance care planning discussions serve two main purposes. First these discussions give patients time to think about Ki16198 the issues they may have to face in the future. Second they give patients the opportunity to discuss their wishes with their family members and medical care team (5 6 Often these discussions result in less aggressive care at the end-of-life and increased hospice utilization (7 8 Unfortunately many patients do not have early advance care planning discussions with their providers (9 10 As a result many patients experience aggressive medical care ranging from chemotherapeutic administration to multiple hospital admissions in the final days of life (7 8 While there is no universal definition of what constitutes aggressive medical care at the end of life several researchers use the following metrics identified by the National Quality Forum: chemotherapy administration within the last 14 days of life more than one emergency room visit in the last 30 days of life more than one hospital admission in the last 30 days of life more than 14 days spent admitted to the hospital in the last Ki16198 30 days of life intensive care unit (ICU) admission in the last 30 days of life death in the hospital and hospice admission during the last three days of life (7 8 11 12 For those patients who will eventually succumb to their disease hospice care provides an alternative to aggressive medical care at the end of life by allowing the patient to transition from the active treatment of disease to the management of symptoms and identification of expectations surrounding death. In addition to the benefits provided to the individual patient hospice provides benefits on a global healthcare level. Recent studies demonstrate decreased utilization of hospital resources (i.e. procedures admissions) and increased medical costs savings Rabbit Polyclonal to MLF1. among patients enrolled in hospice (13-15). In order to efficiently utilize the limited health care dollars available we must evaluate the benefits of aggressive measures taken at the end of life. Ovarian cancer is often diagnosed at an advanced stage and has the highest mortality rate among gynecologic cancers (16). Overall survival is poor with a 5-year survival rate of 40-50% following initial diagnosis (17 18 Limited studies have evaluated the medical care received by ovarian cancer patients at the end of life (8 19 The primary objective of this study was to assess patterns of medical care hospice utilization and aggressive medical care among ovarian cancer patients at our institution in the last 30 days of life. A secondary.