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In most terminally ill cancer patients, discussions about end-of-life care first are broached in the hospital setting. However, we know little about these conversations.
Researchers at a single center in Michigan performed a retrospective cohort study of adult patients with advanced cancer who died during their hospitalizations between 2004 and 2007. Of 145 inpatients, 115 had capacity for medical decisions on admission. Of these, 49% participated in an end-of-life discussion during their hospital stay and 40% lost decision-making capacity before such discussions, requiring surrogates to speak on their behalf. In 13, no such conversations were documented during their hospitalizations. The patients for whom surrogates made decisions received …