Advance directives among patients with advanced cancer in Mexico.

Authors

Yanin Chavarri Guerra

Yanin Chavarri Guerra

Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, DF, Mexico

Yanin Chavarri Guerra, Wendy Alicia Ramos-Lopez, Sofía Sánchez-Román, Paulina Quiroz, Alfredo Covarrubias-Gómez, Natasha Alcocer, Andrea Morales Alfaro, María Reneé Jiménez Sotomayor, Roberto Gonzalez Salazar, Araceli Carrillo Bedoya, Ariana Michael Jimenez Cruz, Monica Carrillo, Karen Eloisa Garcia Dominguez, Aimee Cristina Madariaga Cobos, Montserrat Amaya Caballero, Enrique Soto Pérez de Celis

Organizations

Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, DF, Mexico, Salvador Zubirán National Institute of Health Sciences and Nutrition, Mexico City, Mexico, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, DF, Mexico, Universidad de Sonora, Hermosillo, Mexico, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Research Funding

No funding received
None.

Background: Completion of advance directives can help to ensure consistency with people´s preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective: To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Methods: We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Results: From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Forty-three (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusions: In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

End-of-Life Care

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 186)

DOI

10.1200/JCO.2022.40.28_suppl.186

Abstract #

186

Poster Bd #

A11

Abstract Disclosures

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