Clinical StudiesOutcomes, preferences for resuscitation, and physician-patient communication among patients with metastatic colorectal cancer☆
Section snippets
Patient population
The data in this study were collected as part of SUPPORT, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. SUPPORT investigators collected information on patient, doctor, and surrogate decision making in seriously ill patients at five academic acute care teaching hospitals: Beth Israel Hospital in Boston, Massachusetts; MetroHealth Medical Center in Cleveland, Ohio; Duke University Medical Center in Durham, North Carolina; St. Joseph’s Hospital in
Description of study population
A total of 520 patients with colorectal cancer were enrolled in SUPPORT (Table 1). The median age was 64 at study entry (interquartile range 56 to 71) and the median years of education was 12 (interquartile range 11 to 14). Eighty-five percent were white, 9% black, and 4% were Hispanic.
Most of the patients (96%) had received at least one cancer therapy. While the selection criteria required only the presence of a single liver metastasis, 57% had additional liver, lung, or pleural metastases.
Discussion
Among patients with metastatic colorectal cancer, almost 2 in 5 of those with a preference did not want CPR. Factors independently associated with this choice included older age, worse quality of life, presence of lung metastases, and a perception of a worse prognosis. All four of these factors were associated with higher mortality at 2 months, and may indicate that patient prognosis is the chief influence on decisions about CPR.
Of the patients who preferred not to have CPR, more than half did
Acknowledgements
The authors wish to thank Jane Soukup, MS, for assistance in data management, Erin Hartman, MS, for editorial support, and Candance Fifer for support in preparation of the manuscript.
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Supported by the Robert Wood Johnson Foundation. The opinions and findings contained herein are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees. Dr. Haidet was supported in part by National Research Service Award No. PE11001-09.