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• W4211022283 abstract "end-of-life; care: end-of-life; careRecent research suggests that discussions about end-of-life decisions occur too late in the illness course of patients with high-risk acute myeloid leukemia (AML), according to findings presented by study author Hannah R. Abrams, MD, of Massachusetts General Hospital, during the American Society of Hematology 2021 Annual Meeting & Exposition (Abstract 109). “Code status refers to whether a patient is willing to undergo CPR or mechanical ventilation intubation if their heart stops or they can't breathe on their own,” she noted during a press briefing. “While this is one set of medical decisions, changing code status often signifies a turning point in how patients—particularly ill patients—think about how they would want to pursue intensive medical care near the end of life if that were to be warranted. “We know that patients with AML often need intensive care near the end of life, and often have poor outcomes if they do require CPR,” she continued. “Despite this, we know that patients and clinicians have different perceptions about their treatment prognosis and even the goals themselves of the treatment that they're receiving.” Key Takeaways Abstract 109 To better under the intricacies of these conversations, the researchers conducted a mixed qualitative/quantitative methods study of 200 patients with high-risk AML to describe code status transitions. “Two physicians used consensus-driven medical record review to characterize code status transitions from time of diagnosis to death and identify patient, family, and palliative care involvement,” according to Abrams and colleagues. “Code status was coded as ‘full’ (confirmed or presumed), ‘restricted’ (i.e., do not resuscitate), or ‘comfort measures only.’” At the time of diagnosis, Abrams reported that 86 percent of patients were “full code” (38.5% presumed, 47.5% confirmed), which means they would receive intubation and CPR if those measures were deemed warranted. “Remarkably, 38.5 percent of patients at the time of diagnosis with high-risk AML—despite the known poor prognosis and intensive care needs—did not have this discussed and were instead presumed to be ‘full code’ at a time of diagnosis,” she noted. The researchers categorized the types of conversations that patients and clinicians are having as follows: pre-emptive conversations that occurred prior to any change in a patient's clinical status (15.6%); anticipatory conversations that happened at the time of or shortly after acute clinical deterioration (32.2%); and informative conversations that occurred following acute clinical deterioration at which point clinicians have deemed CPR or intubation to likely be futile (51%). “Over half of all code status transitions in these patients with high-risk AML happened in the last 2 weeks of life,” Abrams noted, while discussing her team's key findings. “Only 60.5 percent of patients were able to be involved in their own final code status transition due to the degree of illness at that point in time.” This suggests that about 40 percent of patients were too ill to indicate their end-of-life preferences during these conversations, putting families in a position where they had to make these decisions without input from their loved one. Abrams reported that 26.3 percent of code status transitions occurred in the ICU or emergency department. “Overall, there was a median of 2 days between final code status change and death. This was slightly longer for older adult patients,” she said. “And, as you can imagine, those patients whose final conversation was an informative modality—in which clinicians informed patients of the futility of further care—had a shorter time frame between final code status change and death.” The researchers also found that palliative care specialists were involved in only 42.1 percent of final code transitions, which underscores the need for future efforts focused on optimizing access to palliative care among patients with high-risk AML. These findings highlight that code status transitions are occurring very late in the illness course for high-risk AML patients, according to Abrams. “They're often occurring in a futility or informative mode and, because of these two things, patients are often unable to engage in these conversations about their own final code status changes, often leaving this to family and clinicians to try and determine what a patient would want,” she concluded. “Earlier conversations may be able to mitigate this, particularly in the outpatient setting.” Catlin Nalley is a contributing writer." @default.
• W4211022283 created "2022-02-13" @default.
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• W4211022283 date "2022-02-20" @default.
• W4211022283 modified "2023-10-18" @default.
• W4211022283 title "The Importance of Earlier End-of-Life Discussions in High-Risk AML" @default.
• W4211022283 doi "https://doi.org/10.1097/01.cot.0000822024.46724.d1" @default.
• W4211022283 hasPublicationYear "2022" @default.
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