Patient preferences for end-of-life care still ignored in US

Michael Cook
7 Sep 2013
Reproduced with Permission

A new report from the Dartmouth Atlas Project finds that although the use of hospice care for Medicare patients with advanced cancer is increasing, many patients do not receive it until they are literally on their deathbed, within three days of the end of life.

Paradoxically, in 2010, despite increases in the use of hospice care, more patients were also treated in intensive care units (ICUs) in their last month of life than in the period from 2003 to 2007.

Care for elderly cancer patients is often more related to where they live than their own end-of-life preferences. Although fewer died in hospital in 2010 than in 2003-2007, aggressive treatment continues at the end of life. The findings show that just as many patients were likely to receive life-sustaining treatments, such as intubation, a feeding tube, or cardiopulmonary resuscitation, in the final month of life, or to undergo chemotherapy during the last two weeks of life.

"The increase in patients admitted to hospice care only days before death suggests that hospice services are often provided too late to provide much benefit," says David C. Goodman of the Dartmouth Atlas Project.

"Fuller discussions with patients who have advanced cancer on their prognosis and options for care can lead to a better quality of life than many receive today."