Elderly Patients Get Unnecessary End-of-Life Treatments
MONDAY, June 27, 2016 -- People dying naturally of old age often receive unnecessary end-of-life medical treatments in hospitals, a new global study finds.
The Australian-based research found that one-third of patients with advanced, irreversible chronic conditions were given treatments that didn't necessarily benefit them -- including admission to intensive care or chemotherapy -- in the last two weeks of their life. The study also revealed that one-quarter of older patients who had Do-Not-Resuscitate orders were still given cardiopulmonary resuscitation (CPR).
People with serious conditions were subjected to invasive procedures, unnecessary scans and blood tests, intensive heart monitoring and other treatments that did little to alter their outcomes, sometimes against their wishes, the researchers found.
"It is not unusual for family members to refuse to accept the fact that their loved one is naturally dying of old age and its associated complications, and so they pressure doctors to attempt heroic interventions," said study leader Dr. Magnolia Cardona-Morrell. She is with the University of New South Wales' Simpson Centre for Health Services Research.
"Doctors also struggle with the uncertainty of the duration of the dying trajectory and are torn by the ethical dilemma of delivering what they were trained to do, save lives, versus respecting the patient's right to die with dignity," she said in a university news release.
The new research involved a large analysis of 38 studies done in 10 countries during the past 20 years. The review included 1.2 million doctors, patients and their relatives.
"Our findings indicate the persistent ambiguity or conflict about what treatment is deemed beneficial and a culture of 'doing everything possible,' " Cardona-Morrell said.
One possible explanation for the excess tests and treatments is that significant medical advancements have led to unrealistic expectations about the ability of doctors and treatments to ensure patients' survival, the researchers noted.
As the population of older and frail people grows, doctors and caregivers must be able to better recognize when death is imminent and unavoidable, the researchers suggested. More training will help doctors lose their fear of a wrong prognosis and identify patients near the end of their lives, they added.
"More importantly, we have identified measurable indicators and strategies to minimize this type of intervention. An honest and open discussion with patients or their families is a good start to avoid non-beneficial treatments. We hope hospitals can monitor these indicators during their quality improvement activities," Cardona-Morrell said.
The review was published June 27 in the International Journal for Quality in Health Care.
The U.S. National Institute on Aging provides more information on end-of-life care.
Posted: June 2016