Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death

Rashmi K. Sharma, Holly G. Prigerson, Frank J Penedo, Paul K. Maciejewski*

*Corresponding author for this work

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND Patient gender plays a significant role in patient-physician communication, patients' understanding of illness, and the aggressiveness of end-of-life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The current study was aimed at determining whether gender differences exist in the receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and the receipt of EoL ICU care. METHODS This was a multisite, prospective cohort study of patients (n=353) with metastatic cancers who were identified as terminally ill at study enrollment and were interviewed at a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. RESULTS Patients who received ICU care at the EoL were more likely to be Male than those who did not (73% vs 52%, P=.02). After adjustments for potential confounders, Male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than Male patients with no EoL discussion (adjusted odds ratio, 0.26, 95% confidence interval, 0.07-0.91; P=.04). There was no association between EoL discussions and ICU stays near death among feMale patients. CONCLUSIONS Men with advanced cancers are more likely than women to receive aggressive, nonbeneficial ICU care near death. Gender differences in the effects of EoL discussions on EoL care likely contribute to and may even explain gender differences in the receipt of ICU care in the last week of life. Cancer 2015;121:2814-2820.

Original languageEnglish (US)
Pages (from-to)2814-2820
Number of pages7
JournalCancer
Volume121
Issue number16
DOIs
StatePublished - Aug 1 2015

Fingerprint

Critical Care
Terminal Care
Intensive Care Units
Terminally Ill
Neoplasms
Caregivers
Cohort Studies
Odds Ratio
Communication
Prospective Studies
Confidence Intervals
Interviews
Physicians

Keywords

  • advanced cancer
  • communication
  • end-of-life care
  • end-of-life discussions
  • gender differences

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sharma, Rashmi K. ; Prigerson, Holly G. ; Penedo, Frank J ; Maciejewski, Paul K. / Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death. In: Cancer. 2015 ; Vol. 121, No. 16. pp. 2814-2820.
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title = "Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death",
abstract = "BACKGROUND Patient gender plays a significant role in patient-physician communication, patients' understanding of illness, and the aggressiveness of end-of-life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The current study was aimed at determining whether gender differences exist in the receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and the receipt of EoL ICU care. METHODS This was a multisite, prospective cohort study of patients (n=353) with metastatic cancers who were identified as terminally ill at study enrollment and were interviewed at a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. RESULTS Patients who received ICU care at the EoL were more likely to be Male than those who did not (73{\%} vs 52{\%}, P=.02). After adjustments for potential confounders, Male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than Male patients with no EoL discussion (adjusted odds ratio, 0.26, 95{\%} confidence interval, 0.07-0.91; P=.04). There was no association between EoL discussions and ICU stays near death among feMale patients. CONCLUSIONS Men with advanced cancers are more likely than women to receive aggressive, nonbeneficial ICU care near death. Gender differences in the effects of EoL discussions on EoL care likely contribute to and may even explain gender differences in the receipt of ICU care in the last week of life. Cancer 2015;121:2814-2820.",
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Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death. / Sharma, Rashmi K.; Prigerson, Holly G.; Penedo, Frank J; Maciejewski, Paul K.

In: Cancer, Vol. 121, No. 16, 01.08.2015, p. 2814-2820.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Male-female patient differences in the association between end-of-life discussions and receipt of intensive care near death

AU - Sharma, Rashmi K.

AU - Prigerson, Holly G.

AU - Penedo, Frank J

AU - Maciejewski, Paul K.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - BACKGROUND Patient gender plays a significant role in patient-physician communication, patients' understanding of illness, and the aggressiveness of end-of-life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The current study was aimed at determining whether gender differences exist in the receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and the receipt of EoL ICU care. METHODS This was a multisite, prospective cohort study of patients (n=353) with metastatic cancers who were identified as terminally ill at study enrollment and were interviewed at a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. RESULTS Patients who received ICU care at the EoL were more likely to be Male than those who did not (73% vs 52%, P=.02). After adjustments for potential confounders, Male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than Male patients with no EoL discussion (adjusted odds ratio, 0.26, 95% confidence interval, 0.07-0.91; P=.04). There was no association between EoL discussions and ICU stays near death among feMale patients. CONCLUSIONS Men with advanced cancers are more likely than women to receive aggressive, nonbeneficial ICU care near death. Gender differences in the effects of EoL discussions on EoL care likely contribute to and may even explain gender differences in the receipt of ICU care in the last week of life. Cancer 2015;121:2814-2820.

AB - BACKGROUND Patient gender plays a significant role in patient-physician communication, patients' understanding of illness, and the aggressiveness of end-of-life (EoL) care. However, little is known about the extent to which gender differences in the effects of EoL discussions on EoL care contribute to gender differences in EoL care. The current study was aimed at determining whether gender differences exist in the receipt of intensive care unit (ICU) care near death and in the association between EoL discussions and the receipt of EoL ICU care. METHODS This was a multisite, prospective cohort study of patients (n=353) with metastatic cancers who were identified as terminally ill at study enrollment and were interviewed at a median of 4.1 months before their deaths. Postmortem chart reviews and caregiver interviews documented ICU stays in the last week of life. RESULTS Patients who received ICU care at the EoL were more likely to be Male than those who did not (73% vs 52%, P=.02). After adjustments for potential confounders, Male patients reporting an EoL discussion were less likely to have an ICU stay in the last week of life than Male patients with no EoL discussion (adjusted odds ratio, 0.26, 95% confidence interval, 0.07-0.91; P=.04). There was no association between EoL discussions and ICU stays near death among feMale patients. CONCLUSIONS Men with advanced cancers are more likely than women to receive aggressive, nonbeneficial ICU care near death. Gender differences in the effects of EoL discussions on EoL care likely contribute to and may even explain gender differences in the receipt of ICU care in the last week of life. Cancer 2015;121:2814-2820.

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