ArticleHealthcare (Basel, Switzerland)2026
EHR-Based Advanced Care Planning and Late-Stage Cancer Treatment in a Middle-Income Country: A Retrospective Cohort Study.
Article in Healthcare (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCancer-directed treatment near the end of life may represent low-value, high-intensity care and potential medical futility, but data from middle-income countries are limited. This study used digitally documented advanced care planning (ACP) in the electronic health record (EHR) and indicators of late oncologic interventions (LOI) within 15 and 30 days before death to examine end-of-life care in Brazil.
objectiveTo identify factors associated with LOI near death and to explore whether documented ACP is linked to lower treatment intensity.
designRetrospective cohort study. SETTING/
participantsAdults with metastatic solid tumors who died between January 2022 and December 2023 in two oncology referral hospitals in southern Brazil and had ≥6 months of premortem EHR data. MEASUREMENTS: LOI were defined as systemic anticancer therapy, radiotherapy, or oncologic surgery within 30 days (LOI-30) or 15 days (LOI-15) before death. Independent predictors were estimated by Poisson regression with robust variance.
resultsAmong 79 patients, 21.5% received LOI-30 and 8.9% received LOI-15. Breast and lung cancers were the most common primary sites. LOI-30 was independently associated with age < 60 years (relative risk [RR] 3.76; 95% confidence interval [CI] 1.50-9.44), higher education (RR 2.07; 95% CI 1.07-3.99), and lower platelet count (RR 0.96 per 10,000/µL; 95% CI 0.92-0.99). ACP was documented for 19% of patients and was associated with absence of LOI-30.
conclusionsDigitally visible ACP in the EHR was associated with reduced aggressive end-of-life care. Using existing EHR infrastructure to prompt and standardize ACP documentation may help align care with patient values in middle-income countries.
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