End-of-Life Care Differs Between U.S., Canada, Study Finds
WEDNESDAY, May 18 -- End-of-life care for older people with advanced lung cancer differs in the United States and in the Canadian province of Ontario, a new study says.
U.S. patients receive far more chemotherapy, while patients in Ontario make much more use of hospital and emergency room services, according to the analysis of data from the U.S. government and the Ontario Cancer Registry. The information was collected from people 65 and older who died from non-small-cell lung cancer between 1999 and 2003.
Health-care services were used extensively by patients in both countries, particularly in the last month of life. More than twice as many people in Ontario died in a hospital (48.5 percent vs. 20.4 percent), even though most patients in Ontario have said they want to die at home, the study reported.
Elderly people in both the United States and Canada receive government-financed health care, but there are differences in end-of-life coverage. In the United States, hospice care for qualified patients is covered by Medicare. Ontario has no hospice program comparable to what's available in the United States, but the province provides palliative care through hospital acute-care units, outpatient services and home health care.
According to the researchers, lack of hospice services in Canada contributes to Ontario's higher rates of hospital and emergency room visits and in-hospital deaths.
The findings, published online May 18 in the Journal of the National Cancer Institute, could help show health planners and policy makers where changes in practices or programs could improve care for dying patients, the researchers said.
End-of-life care also varies from region to region in the United States and Canada, Dr. David Goodman, of the Dartmouth Institute for Health Policy and Clinical Practice, wrote in an accompanying journal editorial.
In addition, patient preferences vary from person to person, and these preferences often go unheard, he said. The best type of end-of-life care, Goodman said, involves the patient in the decision making.
Posted: May 2011
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