Association of performance status, depression, and demographics with advance directive documentation in patients with glioblastoma.

purposeFor those with a life-limiting illness, advance care planning (ACP) is essential for patient-centered care. However, there is limited research available on the timing and impact of ACP on patients with brain tumors, particularly with glioblastoma. The primary aim of this study was to determine if there is a relationship between advance directive (AD) documentation, a part of ACP, and depression, performance status scores, or demographics of patients with glioblastoma.

methodsThe sample consisted of 146 patients with glioblastoma, 98 of whom had documented AD, defined as within the 14 days prior to diagnosis or during their disease course, at a single comprehensive cancer center. Demographic characteristics, depression scores, performance status scores, and AD documentation were extracted from electronic medical records over repeated clinical time points. Logistic regression, mixed model, and generalized estimating equations models were used to assess relationships between patient variables and documentation of AD.

resultsNo statistically significant difference in depression scores was found between those with and without documented AD. There was a statistically significant difference in performance status, such that those with worse performance status were more likely to have a documented AD. Patients who were female, older, and not married were more likely to have documented AD.

conclusionIn our sample, AD was more likely to be established for patients with advanced disease and specific demographic factors, whereas depression scores did not predict presence or absence of AD. This may indicate that patients with decreased performance status may be more receptive to completing AD than those with better performance status. Alternatively, it could reflect that providers are more likely to approach the subject as their health deteriorates. Patients preparing for neurosurgical intervention might be more receptive to AD completion and ACP discussion than patients in other phases of care. We offer recommendations to promote a more proactive approach to AD so that more patients are prepared by the time their performance status starts to decline.