OUTCOMES, PREFERENCES FOR RESUSCITATION, AND PHYSICIAN-PATIENT COMMUNICATION AMONG PATIENTS WITH METASTATIC COLORECTAL-CANCER

PURPOSE: To describe characteristics, outcomes, and decision making in patients with colorectal cancer metastatic to the liver, and to exami ne the relationship of doctor-patient communication with patient under standing of prognosis and physician understanding of patients' treatme nt preferences. PATIENTS AND METHODS: The Study to Understand Prognose s and Preferences for Outcomes and Risks of Treatments (SUPPORT) was a prospective cohort study conducted at five teaching hospitals in the United States between 1989 and 1994. Participants in this study were h ospitalized patients 18 years of age or older with known liver metasta ses who had been diagnosed with colorectal cancer at least 1 month ear lier. Data were collected by patient interview and chart review at stu dy entry; patients were inteviewed again at 2 and 6 months. Data colle cted by physician interview included estimates of survival and impress ions of patients' preferences for cardiopulmonary resuscitation (CPR). Patients and physicians were also asked about discussions about progn osis and resuscitation preferences. RESULTS: We studied 520 patients w ith metastatic colorectal cancer (median age 64, 56% male, 80% white, 2-month survival 78%, 6-month survival 56%). Quality of life (62% ''go od'' to ''excellent'') and functional status (median number of disabil ities = 0) were high at study entry and remained so among interviewed survivors at 2 and 6 months. Of 339 patients with available informatio n, 212 (63%) of 339 wanted CPR in the event of a cardiopulmonary arres t. Factors independently associated with preference for resuscitation included younger age, better quality of life, absence of lung metastas es, and greater patient estimate of 2-month prognosis. Of the patients who preferred not to receive CPR, less than half had a do-not-resusci tate note or order written. Patients' self-assessed prognoses were les s accurate than those of their physicians. Physicians incorrectly iden tified patient CPR preferences in 30% of cases. Neither patient progno stication nor physician understanding of preferences were significantl y better when discussions were reported between doctors and patients. CONCLUSIONS: A majority of patients with colorectal cancer have prefer ences regarding end of life care. The substantial misunderstanding bet ween patients and their physicians about prognosis and treatment prefe rences appears not to be improved by direct communication. Future rese arch focused on enhancing the effectiveness of communication between p atients and physicians about end of life issues is needed. (C) 1998 by Excerpta Medica, Inc.