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Final Program


Palliative Care

PO-033

(PO-033) (PO-033) UCSF End of Life Option Act 2016-2020: A Retrospective Chart Review

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Background:
The End of Life Option Act (EOLOA) went into effect in June 2016 and legalized physician aid-in-dying (PAD) in California. State-level statistics are available on California patients accessing physician aid-in-dying (e.g. in 2018, 51% female and 68.8% had cancer [CDPH, 2019]), but little is known about outcomes at individual institutions. EOLOA requires capacity assessments by one attending and one consulting physician. At UCSF Medical Center (UCSFMC), all patients must also undergo a formal mental health assessment prior to being prescribed PAD medications (Bourgeois, 2018).

Methods:
We conducted a retrospective chart review of all adult patients at UCSFMC who were prescribed PAD medications from June 2016-May 2020. Patients (n=74) were identified by a systematic search of medical center pharmacy records, supplemented by lists of patients known to the UCSF Psychiatry and Palliative Care services. Descriptive statistics will be presented regarding patient demographics and clinical characteristics. This study was approved by the UCSF IRB (#19-29153).

Results:
Data collection is ongoing and up-to-date data will be presented. These data expand upon our prior work (previously presented as Martin, 2021), a chart review of a convenience sample (n=42) of UCSF patients who requested PAD 2016-2019. Our prior chart review found that patients requesting PAD were older (median 66 years), 50% female, 81.0% White, and 28.6% identified as religious. Seventy-three percent had cancer. A majority (69.0%) of patients were prescribed PAD medications.

Discussion:
This is the first attempt to gather data on all patients prescribed PAD medications at UCSFMC. Presented data will include demographics and clinical characteristics, including mental health diagnoses and patients’ reasons for electing PAD. Data will be compared to available state-level statistics.

Conclusion:
The need for mental health assessments for patients electing for PAD has long been debated (Ganzini, 2008); however, there are very limited data describing this population or the reasons individuals request PAD. Both empirical health-system and state-level assessments are necessary for practice and policy improvements.

References:
1. California Department of Public Health: California End of Life Option Act 2018 Data Report. https://www.cdph.ca.gov/Programs/CHSI/Pages/End-of-Life-Option-Act-.aspx Accessed March 26, 2021
2. Bourgeois JA, Mariano MT, Wilkins JM, Brendel RW, Kaplan L, Ganzini L. Physician-Assisted Death Psychiatric

Assessment: A Standardized Protocol to Conform to the California End of Life Option Act. Psychosomatics. 2018 Sep-Oct;59(5):441-451. doi: 10.1016/j.psym.2018.02.003. Epub 2018 Mar 2. PMID: 29653821.
3. Martin J, Weaver E, Rabow M, Kaplan L, Anderson B. UCSF End of Life Option Act 2016-2019: A Retrospective Chart Review Pilot. American Academy of Hospice and Palliative Medicine. February, 2021.
4. Ganzini L, Goy ER, Dobscha SK. Prevalence of depression and anxiety in patients requesting physicians' aid in dying: cross sectional survey. BMJ. 2008 Oct 7;337:a1682. doi: 10.1136/bmj.a1682. PMID: 18842645; PMCID: PMC2562435.

Learning Objectives:

  • Describe the demographics and clinical characteristics of patients accessing physician aid-in-dying at an academic medical center.
  • Describe the most common reasons that patients requested physician aid-in-dying at an academic medical center.