Patients get more aggressive end-of-life interventions when physicians take over decision-making, study finds

Caregiver end of life care nursing home palliative care
Patients who let doctors call the shots may not receive the kind of end-of-life care they want. (Getty/KatarzynaBialasiewicz)

Terminally ill patients who request that physicians make decisions for them get more aggressive end-of-life treatment, according to a new study.

The study, published in the Journal of Pain and Symptom Management, looked at patients' and physicians' personal beliefs and attitudes and how they affect end-of-life care.

The study found dying patients who rely on physicians to make decisions for them are more likely to receive more aggressive or experimental treatments in the weeks before they die.

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That may mean patients don't receive the kind of care they really want at the end of life.

“Some physicians are very comfortable taking over the decision-making for their terminally ill patients. An important and surprising finding is that when physicians do take charge of treatment decisions, patients are more likely to receive aggressive interventions at the end of life,” lead author Paul Duberstein, chair of the Department of Health Behavior, Society and Policy at Rutgers School of Public Health, said in a study announcement.

“As a result, patients end up in intensive care units or emergency rooms in the days before death, even though most people would rather die peacefully at home,” he said.

The study, in which researchers examined chemotherapy use and hospitalizations or emergency department visits in the last 30 days of 265 patients under the care of 38 oncologists, highlights the need for better education about end-of-life care.

Attitudes of both physicians and patients influenced end-of-life care, the study found. Patients of physicians who were comfortable offering aggressive medical interventions were more likely to receive chemotherapy and undergo hospitalizations in the days and weeks before dying.

Patients who had unfavorable attitudes toward palliative care and those who wanted to try experimental treatments were also more likely to receive aggressive interventions.

“We need to do a much better job teaching doctors about the psychology of death and dying, improving the way we educate the public about the benefits of palliative care and providing care for patients and families with advanced disease,” Duberstein said.

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