Patient Wishes Should Guide End-of-Life Care, Researchers Say

THURSDAY March 21, 2013 -- Dying patients are happier, less depressed, have less pain and survive longer when their end-of-life care wishes are known and followed, researchers report.

This type of patient-centered care can also help keep health costs down for patients who don't want aggressive treatment, the University of California, Los Angeles (UCLA) research team said.

"You can improve care while reducing cost by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants," Dr. Jonathan Bergman, a clinical scholar and fellow in the urology department, said in a university news release.

In many cases, dying patients are given aggressive treatments that don't help them and result in higher costs, according to the article in the March 20 issue of the journal JAMA Surgery.

Patients who want aggressive care should receive it, but many don't want it and haven't been asked about their wishes, according to Bergman and colleagues, who are testing patient-centered care on cancer patients.

To change the situation, doctors need to be educated about patient-centered care, the researchers said. They also suggested that changes to Medicare should be considered. But this is a highly controversial topic that has been sidelined after recent suggested changes were characterized as creating "death panels."

"Given the disproportionate cost of care at the very end of life, the issue should be revisited," Bergman and colleagues wrote. "Addressing goals of care, not to deny aggressive care to those who want it, but to ensure that we deliver aggressive care only to those who do, reduces costs and improves outcomes."

The study authors noted that, according to the results of a 2004 study, 30 percent of Medicare dollars are spent on the 5 percent of beneficiaries who die each year, and one-third of the costs in the final year of life occur during the final month.

Previous research has shown that patient-centered care can reduce the costs in the last week of life by 36 percent and that patients who receive such care are less likely to die in an intensive care unit.

The researchers said that another way to encourage patient-centered care for dying patients is to include it as an accountability measure in the Joint Commission's annual ranking of U.S. hospitals. The commission accredits hospitals.

More information

The AGS Foundation for Health in Aging has more about end-of-life care.

Posted: March 2013


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