FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2891893906> ?p ?o ?g. }

• W2891893906 endingPage "e8" @default.
• W2891893906 startingPage "e6" @default.
• W2891893906 abstract "Despite multimodality treatment including surgery, radiation, and chemotherapy, glioblastoma of the brain remains a terminal and life-altering diagnosis, with a median survival of less than two years. Patients with glioblastoma have the concurrent diagnoses of a cancer and a progressive neurological disease and often have a high burden of associated symptoms that impair not only the patient's quality of life but also decision-making capacity. At diagnosis, about half of patients with primary malignant brain tumors including glioblastoma already have compromised medical decision–making capacity due to cognitive impairment, behavioral changes, and/or poor communication, and this percentage increases as their disease progresses.1Triebel K.L. Martin R.C. Nabors L.B. Marson D.C. Medical decision-making capacity in patients with malignant glioma.Neurology. 2009; 73: 2086-2092Crossref PubMed Scopus (87) Google Scholar Thus, early introduction of advance care planning (ACP) to facilitate communication of goals and preferences for future medical care is particularly important for patients with glioblastoma. This process includes not only designating treatment preferences and a proxy decision maker but also open communication between patients, proxy decision makers, and providers about preferences and goals around future medical care. The American Society of Clinical Oncology's (ASCO) Quality Oncology Practice Initiative (QOPI) recommends documenting patients' advance directives by the third office visit as a metric for quality cancer care.2QOPI-Related Measures | ASCO Practice Central.https://practice.asco.org/quality-improvement/quality-programs/quality-oncology-practice-initiative/qopi-related-measuresDate accessed: May 30, 2018Google Scholar Palliative care to maximize quality of life is similarly indicated for advanced cancers.3Temel J.S. Greer J.A. Muzikansky A. et al.Early palliative care for patients with metastatic non-small-cell lung cancer.N Engl J Med. 2010; 363: 733-742Crossref PubMed Scopus (5006) Google Scholar We aimed to describe ACP documentation and referral to palliative care and hospice among patients with glioblastoma undergoing radiation therapy at a large academic center. Postoperative radiation for glioblastoma commonly comprises six weeks of daily treatment, thus providing radiation oncologists a unique opportunity to play an integral role in the provision of ACP and palliative care to this vulnerable population. Improved understanding of ACP, palliative care, and hospice needs among patients with glioblastoma can inform efforts to improve care for this population both throughout treatments and at the end of life. We performed a retrospective, institutional review board–approved study of consecutive adult patients with newly diagnosed glioblastoma, treated with radiation at Stanford between 2014 and 2015 to allow for adequate follow-up. We determined the proportion of patients who had ACP documentation in their medical record by a hand chart review. ACP included documentation of advance directive, living will, designation of power of attorney, and/or discussions indicating patients' preferences for their end-of-life care. We noted whether patients had ACP documentation before glioblastoma diagnosis, whether ACP documentation had been updated after diagnosis, and whether ACP documentation was present and/or updated within six months after diagnosis, as patients will have undergone most of their initial therapy but not yet have experienced progression or death during this period. We additionally noted whether patients had exposure to ACP education as documented in the chart. Finally, we noted whether patients were referred to palliative care and hospice during their disease course and whether this referral occurred within three days of death, which is one of the ASCO's QOPI end-of-life performance measures.2QOPI-Related Measures | ASCO Practice Central.https://practice.asco.org/quality-improvement/quality-programs/quality-oncology-practice-initiative/qopi-related-measuresDate accessed: May 30, 2018Google Scholar We included 63 patients with glioblastoma in our study (Table 1). Median age was 63 years (range 27–85), and the majority of patients were male (70%) and white (73%). Median survival was 20 months (95% CI 16–24 months).Table 1Baseline Characteristics and Prevalence of Advance Care Planning Among Patients With Glioblastoma Undergoing Radiation TreatmentBaseline and ACP Characteristicsn (%)Total63 (100)Age, yrs (median, range)63 (27–85)Gender Male38 (60) Female25 (40)Race White46 (73) Nonwhite or other17 (27)Performance status ECOG 0–137 (59) ECOG 2–426 (41)ACP present at last follow-up34 (54)ACP before diagnosisaACP documented more than 30 days before diagnosis and not updated after diagnosis.7 (11)ACP within six months of diagnosisbACP updated or documented less than 30 days before diagnosis and within six months after diagnosis.18 (29)Living will documented18 (29)Durable power of attorney documented26 (41)Discussion of resuscitation status documented29 (46)ECOG = Eastern Cooperative Oncology Group; ACP = advance care planning.a ACP documented more than 30 days before diagnosis and not updated after diagnosis.b ACP updated or documented less than 30 days before diagnosis and within six months after diagnosis. Open table in a new tab ECOG = Eastern Cooperative Oncology Group; ACP = advance care planning. Table 1 summarizes prevalence of ACP documentation with a median follow-up of 1.5 years. Of our cohort, 34 (54%) patients had ACP documented at the time of last follow-up, with 18 (29%) patients having ACP documented within six months of diagnosis. Of the 44 decedents, 24 (55%) had ACP documented before death. Only 11 (17%) patients had documented ACP education; two (3%) patients had this education within six months of diagnosis. Of the 29 (66%) decedents with a hospice referral at the time of this analysis, one (2%) decedent had a hospice referral within three days of death. Of the 17 (39%) decedents with a palliative care referral, none had a palliative care referral within three days of death. We found that approximately a third of patients with glioblastoma who underwent radiation at an academic institution completed ACP within six months of diagnosis and were referred to palliative care. Given the integral role that radiation oncologists play in the initial phase of therapy for patients with glioblastoma, our findings importantly highlight an opportunity for the radiation oncology clinical team to partner with palliative care to improve end-of-life care for this vulnerable population. Our ACP rates are similar, if not higher, to what others have reported in similar populations. Prior work suggests that only 6%–31% of patients with primary malignant brain tumors obtain advance directives during their disease course,4Kuchinad K.E. Strowd R. Evans A. Riley W.A. Smith T.J. End of life care for glioblastoma patients at a large academic cancer center.J Neurooncol. 2017; 134: 75-81Crossref PubMed Scopus (13) Google Scholar, 5Golla H. Ahmad M.A. Galushko M. et al.Glioblastoma multiforme from diagnosis to death: a prospective, hospital-based, cohort, pilot feasibility study of patient reported symptoms and needs.Support Care Cancer. 2014; 22: 3341-3352Crossref PubMed Scopus (17) Google Scholar with even fewer obtaining advance directives within the first three visits after diagnosis, as recommended per ASCO's QOPI.2QOPI-Related Measures | ASCO Practice Central.https://practice.asco.org/quality-improvement/quality-programs/quality-oncology-practice-initiative/qopi-related-measuresDate accessed: May 30, 2018Google Scholar We found that more than half of the patients with glioblastoma did eventually have ACP at some point before death. The optimal time to initiate ACP discussions among patients with glioblastoma is not clear, as ACP could be introduced at diagnosis, after initial surgery, during or after radiation or adjuvant chemotherapy, and/or at the time of recurrence. We, as well as other neuro-oncology specialists,6Walbert T. Maintaining quality of life near the end of life: hospice in neuro-oncology.Neuro-Oncol. 2018; 20: 439-440Google Scholar recommend that ACP starts early and continues throughout the disease course given the aggressive nature of this terminal disease with its frequently concurrent and progressive loss of medical decision making, as well as the possibility of treatment toxicities that can further contribute to neurocognitive decline.1Triebel K.L. Martin R.C. Nabors L.B. Marson D.C. Medical decision-making capacity in patients with malignant glioma.Neurology. 2009; 73: 2086-2092Crossref PubMed Scopus (87) Google Scholar Given that radiation is typically given daily, over six weeks, as part of standard upfront treatment for glioblastoma, this time period may be conducive for the early introduction of ACP in this patient population. Early integration of palliative care in the treatment course is important for cancer patients3Temel J.S. Greer J.A. Muzikansky A. et al.Early palliative care for patients with metastatic non-small-cell lung cancer.N Engl J Med. 2010; 363: 733-742Crossref PubMed Scopus (5006) Google Scholar and even more so for patients with incurable brain tumors. However, we found that only 66% and 39% of decedents in our study had hospice and palliative care referrals, respectively. These numbers are lower than what has been reported for other serious illnesses such as end-stage renal disease and dementia.7Wachterman M.W. Pilver C. Smith D. Ersek M. Lipsitz S.R. Keating N.L. Quality of end-of-life care provided to patients with different serious illnesses.JAMA Intern Med. 2016; 176: 1095-1102Crossref PubMed Scopus (203) Google Scholar Thus, there are opportunities to improve the quality of palliative and end-of-life care in this cohort, and ACP may be one approach through which this can be accomplished.8Detering K.M. Hancock A.D. Reade M.C. Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.BMJ. 2010; 340: c1345Crossref PubMed Scopus (1523) Google Scholar Our analysis was limited to only data recorded in an electronic medical record at a single academic institution during a two-year period. With increasing awareness of importance of ACP and palliative care, these numbers have changed over time. Some patients may have participated in ACP that may not have been documented in the chart. However, most glioblastoma patients require an inpatient admission for diagnosis, and our institution documents in the medical chart for all admitted patients whether they have completed an advance directive. Thus, most patients in our study had at least one assessment of ACP during their treatment course. In addition, ACP has evolved from a legal, document-driven effort to a broader process of communication whereby patients, through discussions with health care providers and proxies, identify their values, beliefs, goals of care and make decisions about future health care,9Sudore R.L. Fried T.R. Redefining the “planning” in advance care planning: preparing for end-of-life decision making.Ann Intern Med. 2010; 153: 256-261Crossref PubMed Scopus (596) Google Scholar and how this is implemented in practice is variable and can be difficult to document. Future work on facilitating timely ACP and advocating for timely referral to palliative care and hospice among glioblastoma patients is needed. Adapting and/or implementing preexisting patient-facing ACP tools, such as PREPARE,10Sudore R.L. Knight S.J. McMahan R.D. et al.A novel website to prepare diverse older adults for decision making and advance care planning: a pilot study.J Pain Symptom Manage. 2014; 47: 674-686Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar for this population may be a promising strategy. Engagement with glioblastoma patients and their families about how to best initiate ACP is a clear opportunity for more and better patient-centered research involving close partnership between patients, family members, clinicians, and researchers. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors." @default.
• W2891893906 created "2018-09-27" @default.
• W2891893906 creator A5016891578 @default.
• W2891893906 creator A5064421397 @default.
• W2891893906 creator A5072792947 @default.
• W2891893906 creator A5073413027 @default.
• W2891893906 creator A5074076985 @default.
• W2891893906 creator A5090345791 @default.
• W2891893906 date "2018-12-01" @default.
• W2891893906 modified "2023-09-26" @default.
• W2891893906 title "Advance Care Planning Needs in Patients With Glioblastoma Undergoing Radiotherapy" @default.
• W2891893906 cites W1977656112 @default.
• W2891893906 cites W1992355053 @default.
• W2891893906 cites W2075954477 @default.
• W2891893906 cites W2127515011 @default.
• W2891893906 cites W2147016542 @default.
• W2891893906 cites W2154573106 @default.
• W2891893906 cites W2461307610 @default.
• W2891893906 cites W2615649280 @default.
• W2891893906 cites W2791000200 @default.
• W2891893906 doi "https://doi.org/10.1016/j.jpainsymman.2018.08.021" @default.
• W2891893906 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/6338473" @default.
• W2891893906 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/30201484" @default.
• W2891893906 hasPublicationYear "2018" @default.
• W2891893906 type Work @default.
• W2891893906 sameAs 2891893906 @default.
• W2891893906 citedByCount "8" @default.
• W2891893906 countsByYear W28918939062020 @default.
• W2891893906 countsByYear W28918939062021 @default.
• W2891893906 countsByYear W28918939062022 @default.
• W2891893906 countsByYear W28918939062023 @default.
• W2891893906 crossrefType "journal-article" @default.
• W2891893906 hasAuthorship W2891893906A5016891578 @default.
• W2891893906 hasAuthorship W2891893906A5064421397 @default.
• W2891893906 hasAuthorship W2891893906A5072792947 @default.
• W2891893906 hasAuthorship W2891893906A5073413027 @default.
• W2891893906 hasAuthorship W2891893906A5074076985 @default.
• W2891893906 hasAuthorship W2891893906A5090345791 @default.
• W2891893906 hasBestOaLocation W28918939061 @default.
• W2891893906 hasConcept C126838900 @default.
• W2891893906 hasConcept C159110408 @default.
• W2891893906 hasConcept C177713679 @default.
• W2891893906 hasConcept C19527891 @default.
• W2891893906 hasConcept C2776194525 @default.
• W2891893906 hasConcept C2777995714 @default.
• W2891893906 hasConcept C2994186709 @default.
• W2891893906 hasConcept C502942594 @default.
• W2891893906 hasConcept C509974204 @default.
• W2891893906 hasConcept C71924100 @default.
• W2891893906 hasConceptScore W2891893906C126838900 @default.
• W2891893906 hasConceptScore W2891893906C159110408 @default.
• W2891893906 hasConceptScore W2891893906C177713679 @default.
• W2891893906 hasConceptScore W2891893906C19527891 @default.
• W2891893906 hasConceptScore W2891893906C2776194525 @default.
• W2891893906 hasConceptScore W2891893906C2777995714 @default.
• W2891893906 hasConceptScore W2891893906C2994186709 @default.
• W2891893906 hasConceptScore W2891893906C502942594 @default.
• W2891893906 hasConceptScore W2891893906C509974204 @default.
• W2891893906 hasConceptScore W2891893906C71924100 @default.
• W2891893906 hasIssue "6" @default.
• W2891893906 hasLocation W28918939061 @default.
• W2891893906 hasLocation W28918939062 @default.
• W2891893906 hasLocation W28918939063 @default.
• W2891893906 hasLocation W28918939064 @default.
• W2891893906 hasOpenAccess W2891893906 @default.
• W2891893906 hasPrimaryLocation W28918939061 @default.
• W2891893906 hasRelatedWork W144772298 @default.
• W2891893906 hasRelatedWork W1971281092 @default.
• W2891893906 hasRelatedWork W2037952949 @default.
• W2891893906 hasRelatedWork W2139724099 @default.
• W2891893906 hasRelatedWork W2280616707 @default.
• W2891893906 hasRelatedWork W2384708512 @default.
• W2891893906 hasRelatedWork W2777195631 @default.
• W2891893906 hasRelatedWork W2908907625 @default.
• W2891893906 hasRelatedWork W2950928838 @default.
• W2891893906 hasRelatedWork W4229066459 @default.
• W2891893906 hasVolume "56" @default.
• W2891893906 isParatext "false" @default.
• W2891893906 isRetracted "false" @default.
• W2891893906 magId "2891893906" @default.
• W2891893906 workType "article" @default.