Quality of end-of-life care better for some illnesses than others, study says


Patients with cancer or dementia have experienced an improvement in end-of-life care, but care quality continues to lag among patients suffering from other serious illnesses, according to a study published in JAMA Internal Medicine.

The study surveyed families of about 34,000 patients who died in the Veterans Affairs health system over a three-year period, and found that about 60 percent of patients with cancer or dementia got excellent end-of-life care. For other conditions, however, that number dropped to 54 or 55 percent. Perhaps more tellingly, patients with conditions other than cancer or dementia were significantly less likely to have received a palliative-care consultation, according to the study.

The study’s principal author, Melissa Wachterman, M.D., who practices at the VA Boston Healthcare System and Brigham and Women’s Hospital, stresses the importance of having end-of-life conversations sooner rather than later, which may be easier to do with serious illnesses such as advanced cancer. Despite incentives provided by new Medicare billing codes for palliative care, many physicians continue to express discomfort when it comes to discussing end-of-life issues with their patients, according to an article in Kaiser Health News.

Improved end-of-life care for cancer patients has been an area of industry focus, but Wachterman points out that the majority of people don’t die of cancer. Getting patients the care they want at the end of life means making the difficult conversations around advance planning a part of routine care, she says, in part because some patients want more aggressive interventions than others.

That will require more effort across the board to encourage both doctors and patients to engage in discussions, says Harriet Warshaw, executive director of the Conversation Project, which advocates for better end-of-life planning. Research shows patients have an interest in these conversations, so “it’s about getting physicians over the fear of raising this,” she says.

The U.S. Senate Special Committee on Aging last week heard testimony from Boston surgeon Atul Gawande, M.D., and palliative care experts about doctors’ reluctance to discuss end-of-life issues with patients.  “People have priorities in their lives besides just living longer,” Gawande said, but the way to learn those priorities to ask patients.

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