Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service: A Retrospective Case-Note Audit

Sophie Fletcher, Rachel Hughes, Sarah Pickstock, Kirsten Auret

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Adolescents and young adults (AYA) with cancer are a cohort requiring specialized healthcare models to address unique cognitive and physical challenges. Advance care planning (ACP) discussions likely warrant age-Appropriate adaptation, yet, there is little Australian research data available to inform best practice for this group. The goal of this work is to inform future models of ACP discussions for AYA. Methods: Retrospective medical record audit of AYA patients and an adult comparison group, diagnosed with a malignancy and referred to a community hospice service, in Western Australia, in the period between January 1, 2012 and December 1, 2015. Information was collected regarding end-of-life care discussions, documentation of agreed plan of care, and care received. Results: Twenty-seven AYA and 37 adult medical records were reviewed. Eighteen (66.7%) AYA patients died at home, compared with 19 (51.4%) adults (p = 0.028). Desire to pursue all available oncological therapies, including clinical trials, was documented for 14 (51.9%) AYA patients compared with 9 (24.3%) of the adult group (p = 0.02). Eleven AYA patients (40.7%) received chemotherapy during the last month of life compared with two (5.4%) adults (p = 0.001). Conclusions: The results indicate that end-of-life care preferences for this unique cohort may differ from those of the adult population and need to be captured and understood. An ACP document incorporating a discussion regarding goals of care, preferred location of care, preference for place of death, and consent to future intervention, including cardiopulmonary resuscitation and prompts for review, could assist in pursuing this objective.

Original languageEnglish
Pages (from-to)112-119
Number of pages8
JournalJournal of Adolescent and Young Adult Oncology
Volume7
Issue number1
DOIs
Publication statusPublished - 1 Feb 2018

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Advance Care Planning
Palliative Care
Young Adult
Neoplasms
Terminal Care
Medical Records
Medical Audit
Patient Care Planning
Western Australia
Hospices
Social Welfare
Cardiopulmonary Resuscitation
Practice Guidelines
Documentation
Clinical Trials
Delivery of Health Care
Drug Therapy

Cite this

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title = "Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service: A Retrospective Case-Note Audit",
abstract = "Purpose: Adolescents and young adults (AYA) with cancer are a cohort requiring specialized healthcare models to address unique cognitive and physical challenges. Advance care planning (ACP) discussions likely warrant age-Appropriate adaptation, yet, there is little Australian research data available to inform best practice for this group. The goal of this work is to inform future models of ACP discussions for AYA. Methods: Retrospective medical record audit of AYA patients and an adult comparison group, diagnosed with a malignancy and referred to a community hospice service, in Western Australia, in the period between January 1, 2012 and December 1, 2015. Information was collected regarding end-of-life care discussions, documentation of agreed plan of care, and care received. Results: Twenty-seven AYA and 37 adult medical records were reviewed. Eighteen (66.7{\%}) AYA patients died at home, compared with 19 (51.4{\%}) adults (p = 0.028). Desire to pursue all available oncological therapies, including clinical trials, was documented for 14 (51.9{\%}) AYA patients compared with 9 (24.3{\%}) of the adult group (p = 0.02). Eleven AYA patients (40.7{\%}) received chemotherapy during the last month of life compared with two (5.4{\%}) adults (p = 0.001). Conclusions: The results indicate that end-of-life care preferences for this unique cohort may differ from those of the adult population and need to be captured and understood. An ACP document incorporating a discussion regarding goals of care, preferred location of care, preference for place of death, and consent to future intervention, including cardiopulmonary resuscitation and prompts for review, could assist in pursuing this objective.",
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Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service : A Retrospective Case-Note Audit. / Fletcher, Sophie; Hughes, Rachel; Pickstock, Sarah; Auret, Kirsten.

In: Journal of Adolescent and Young Adult Oncology, Vol. 7, No. 1, 01.02.2018, p. 112-119.

Research output: Contribution to journalArticle

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