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Survival time was overestimated in 85% of patients for whom medical providers gave inaccurate predictions, and providers were particularly likely to overestimate survival for Black and Latino patients. In a multicenter cohort study of 230 hospitalized patients with advanced cancer, palliative care providers correctly predicted time to death for only 41% of patients. This appears to hold true even for providers who are experienced in treating patients who are terminally ill. However, the available literature suggests that medical providers inaccurately predict how long patients will live and tend to overestimate survival times.

Prognostic information plays an important role for making treatment decisions and planning for the EOL. Providing excellent care toward the end of life (EOL) requires an ability to anticipate when to focus mainly on palliation of symptoms and quality of life instead of disease treatment.

Wright AA, Keating NL, Balboni TA, et al.: Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health.

Hui D, Kim SH, Roquemore J, et al.: Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients.

Temel JS, Greer JA, Muzikansky A, et al.: Early palliative care for patients with metastatic non-small-cell lung cancer.

Balboni TA, Paulk ME, Balboni MJ, et al.: Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death.

Mack JW, Cronin A, Keating NL, et al.: Associations between end-of-life discussion characteristics and care received near death: a prospective cohort study.

Wright AA, Zhang B, Ray A, et al.: Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment.

Dartmouth Institute for Health Policy & Clinical Practice, 2013.

Goodman DC, Morden NE, Chang CH: Trends in Cancer Care Near the End of Life: A Dartmouth Atlas of Health Care Brief.

American Cancer Society: Cancer Facts and Figures 2022.

When specific information about the care of children is available, it is summarized under its own heading. The evidence and application to practice related to children may differ significantly from information related to adults. In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The goal of this summary is to provide essential information for high-quality EOL care. The decisions commonly made by patients, families, and clinicians are also highlighted, with suggested approaches. This summary provides clinicians with information about anticipating the EOL the common symptoms patients experience as life ends, including in the final hours to days and treatment or care considerations.

For more information, see Planning the Transition to End-of-Life Care in Advanced Cancer.

Thus, it is important to help patients and their families articulate their goals of care and preferences near the EOL. In addition, death in a hospital has been associated with poorer quality of life and increased risk of psychiatric illness among bereaved caregivers. Patient recall of EOL discussions, spiritual care, or early palliative care, however, are associated with less-aggressive EOL treatment and/or increased utilization of hospice. Patient and family preferences may contribute to the observed patterns of care at the EOL. Significant regional variations in the descriptors of end-of-life (EOL) care remain unexplained. However, the average length of stay in hospice was only 9.1 days, and 11% of patients were enrolled in the last 3 days of life. Conversely, about 61% of patients who died used hospice service. Approximately 6% of patients nationwide received chemotherapy in the last month of life. In addition, 29% of patients were admitted to an intensive care unit in the last month of life. Across the United States, 25% of patients died in a hospital, with 62% hospitalized at least once in the last month of life. A report of the Dartmouth Atlas Project analyzed Medicare data from 2007 to 2010 for cancer patients older than 65 years who died within 1 year of diagnosis. People with cancer die under various circumstances. Despite progress in developing treatments that have improved life expectancies for patients with advanced-stage cancer, the American Cancer Society estimates that 609,360 Americans will die of cancer in 2022.