Patient-centered palliative care leads to lower costs, happier patients

The medical community can do a better job with expensive end-of-life care, which often is poorly coordinated and fails to acknowledge patient preferences, according to a new perspective piece published in JAMA Surgery.

Patient-centered end-of-life care that avoids aggressive treatments patients might not want also helps reduce costs, researchers from the University of California, Los Angeles Department of Urology noted in their article. They looked at studies analyzing end-of-life preferences, delivering value-congruent care and coordinating the care recommended by healthcare providers.

"When an individual patient's preference is addressed by any clinician, then care delivered at the end of life adheres better to values expressed by that individual," the authors state. "Cost of care in the last week of life can be reduced by 36 percent; death is less likely to occur in an intensive care unit, physical stress is reduced, and all of this can be achieved without shortening survival."

The article points out that neither end-of-life care nor end-of-life counseling is routinely taught in medical school or residency, despite the central role it holds in healthcare delivery. "Our curricula reflect our priorities as a medical community, and we should show that we value end-of-life care by teaching it to each trainee," study authors urge.

The researchers say many physicians are driving costs up by making end-of-life care decisions that don't improve outcomes, like aggressive treatments, with their intentions to prolong life. They also found patient-centered end-of-life care--defined as ensuring that a dying person's wishes are known and followed, without taking aggressive measures a patient doesn't want--resulted in happier patients who survive longer with less pain, according to an announcement from UCLA.

"Patients come in with incurable diseases and there's no discussion of prognosis and goals of care," author Jonathan Bergman, M.D., said in a statement. "Then a lot of very aggressive treatments can occur, due to inertia--patients are placed in an intensive care unit with oxygen and feeding tubes, and that's not always in line with their goals."

Bergman said costs are often lower when treatment plans are tailored to patient goals.

Shortages of palliative-care doctors may be part of the problem. The American Academy of Hospice and Palliative Medicine Workforce Task Force recently reported there is only one palliative care doctor for every 1,300 patients with a serious illness. The healthcare industry needs another 18,000 palliative-care doctors to meet demand, the group said.

To learn more:
- read the study abstract
- read the announcement from UCLA

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