Integrating a question prompt list on an inpatient oncology unit to increase prognostic awareness

Abstract

Background: Many patients with incurable cancer do not accurately understand their prognosis, which can lead to aggressive and, often, futile treatment. Improved prognostic awareness can help patients to appropriately de-escalate aggressive treatment sooner in an illness trajectory. Objectives: The purpose of this article is to introduce a patient-initiated discussion aid (question prompt list) on an oncology unit to increase prognostic awareness by promoting patient–provider dialogue, which could lead to limitation of life-sustaining treatments at the end of life and increased do-not-resuscitate (DNR) orders and hospice referrals. Methods: Medical records of consecutively admitted patients with a solid malignancy who were urgently admitted to the inpatient setting were reviewed for three months to determine the percentage of DNR orders and referrals to hospice care. After inclusion of the communication aid in admission packets, records of consecutively admitted patients to the inpatient setting were reviewed for three months to reassess the percentage of DNR orders and referrals to hospice care. Findings: An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.