Helping patients articulate end-of-life wishes: a target for interprofessional participation

A recent publication in the Journal of Clinical Oncology by researchers at the Massachusetts General Hospital described the effect of timely e-mail prompts to improve documentation of outpatient code status in adult patients with advanced lung cancer (1). This work builds on a 2009 paper describing the initial design and implementation of the code status module within the electronic ambulatory medical record (2). The code status module is a feature in the hospital’s outpatient record that allows clinicians to document a patient’s preferences for end of life care (e.g., full code, DNR/DNI, or other resuscitation options). In the report describing that initial implementation, researchers assessed impact by extracting information from hospital’s clinical database to determine rates of documentation of electronic code status using the new module. In the 22-month period following introduction of the code status module, they found only 20% of patients with a documented outpatient code status (2).