Portable medical orders and end-of-life measures in acute myeloid leukemia and myelodysplastic syndromes

Blood Advances - Tập 5 - Trang 5554-5564 - 2021
Marissa LoCastro1, Andrea M. Baran2, Jane L. Liesveld2, Eric Huselton2, Michael W. Becker2, Kristen Marie O'Dwyer2, Omar S. Aljitawi2, Megan Baumgart2, Eric Snyder2, Benzi Kluger3,4, Kah Poh Loh2, Jason H. Mendler2
1School of Medicine and Dentistry, University of Rochester, Rochester, NY
2Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute
3Department of Neurology
4Division of Palliative Care, Department of Medicine, University of Rochester Medical Center, Rochester, NY

Tóm tắt

Abstract Patients with acute myeloid leukemia (AML) or a myelodysplastic syndrome (MDS) experience high rates of hospitalization, intensive care unit (ICU) admission, and in-hospital death at the end of life. Early goals-of-care (GOC) discussions may reduce the intensity of end-of-life (EOL) care. Portable Medical Order forms, known as Medical Orders for Life-Sustaining Treatment (MOLST) forms in New York state, assist patients in translating GOC discussions into specific medical orders that communicate their wishes during a medical emergency. To determine whether the timing of completion of a MOLST form is associated with EOL care in patients with AML or MDS, we conducted a retrospective study of 358 adult patients with AML or MDS treated at a single academic center and its affiliated sites, who died during a 5-year period. One-third of patients completed at least 1 MOLST form >30 days before death. Compared with patients who completed a MOLST form within 30 days of death or never, those who completed a MOLST form >30 days before death were less likely to receive transfusion (adjusted odds ratio [AOR], 0.39; P < .01), chemotherapy (AOR, 0.24; P < .01), or life-sustaining treatments (AOR, 0.21; P < .01) or to be admitted to the ICU (AOR, 0.21; P < .01) at EOL. They were also more likely to use hospice services (AOR, 2.72; P < .01). Earlier MOLST form completion was associated with lower intensity of care near EOL in patients with MDS or AML.

Tài liệu tham khảo

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Blood Advances

Tập 5

5554-5564

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