Portable medical orders and end-of-life measures in acute myeloid leukemia and myelodysplastic syndromes

Marissa LoCastro, Andrea M Baran, Jane L Liesveld, Eric Huselton, Michael W Becker, Kristen Marie O'Dwyer, Omar S Aljitawi, Megan Baumgart, Eric Snyder, Benzi Kluger, Kah Poh Loh, Jason H Mendler, Marissa LoCastro, Andrea M Baran, Jane L Liesveld, Eric Huselton, Michael W Becker, Kristen Marie O'Dwyer, Omar S Aljitawi, Megan Baumgart, Eric Snyder, Benzi Kluger, Kah Poh Loh, Jason H Mendler

Abstract

Patients with acute myeloid leukemia (AML) or a myelodysplastic syndrome (MDS) experience high rates of hospitalization, intensive care unit (ICU) admission, and in-hospital death at the end of life. Early goals-of-care (GOC) discussions may reduce the intensity of end-of-life (EOL) care. Portable Medical Order forms, known as Medical Orders for Life-Sustaining Treatment (MOLST) forms in New York state, assist patients in translating GOC discussions into specific medical orders that communicate their wishes during a medical emergency. To determine whether the timing of completion of a MOLST form is associated with EOL care in patients with AML or MDS, we conducted a retrospective study of 358 adult patients with AML or MDS treated at a single academic center and its affiliated sites, who died during a 5-year period. One-third of patients completed at least 1 MOLST form >30 days before death. Compared with patients who completed a MOLST form within 30 days of death or never, those who completed a MOLST form >30 days before death were less likely to receive transfusion (adjusted odds ratio [AOR], 0.39; P < .01), chemotherapy (AOR, 0.24; P < .01), or life-sustaining treatments (AOR, 0.21; P < .01) or to be admitted to the ICU (AOR, 0.21; P < .01) at EOL. They were also more likely to use hospice services (AOR, 2.72; P < .01). Earlier MOLST form completion was associated with lower intensity of care near EOL in patients with MDS or AML.

© 2021 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Flowchart describing patient preferences on the first MOLST form. IV, intravenous fluids; MOLST, Medical Orders for Life-Sustaining Treatment.
Figure 2.
Figure 2.
Time from initial MOLST form completion to death as a function of clinician subspecialty. “Unclear” subspecialty refers to providers who could not be identified because the signature on the MOLST form was illegible.
Figure 3.
Figure 3.
Flowchart depicting changes in code status as stated on the MOLST forms. MOLST, Medical Order for Life-Sustaining Treatment.
Figure 4.
Figure 4.
EOL measures in patients with AML and MDS. AML, acute myeloid leukemia; ED, emergency department; ICU, intensive care unit; MDS, myelodysplastic syndrome; MOLST; Medical Order for Life-Sustaining Treatment.
Figure 5.
Figure 5.
Use of life-sustaining treatments in patients with AML and MDS.

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Source: PubMed

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