One study looked at racial and ethnic differences juxtaposed to the cost of end-of-life care. Researchers reviewed the treatment records of nearly 160,000 Medicare patients in the last six months of life. Medicare costs averaged $20,166 for whites, $26,704 for blacks, and $31,702 for Hispanics. The study did not examine reasons why costs varied. Read the Associated Press article for more information.
Another study discussed the role end-of-life conversations between a physician and a patient can play in health care costs during the last week of life. NPR discusses the findings with the study's author, Holly Prigerson. The study included 627 patients with advanced cancer and was funded by the National Institute of Mental Health and the National Cancer Institute. The study concluded that patients who reported discussing end of life with their doctors had lower health care costs. Also, patients whose health care costs were higher had a worse quality of death. Reuter's Andrew Stern reported :
After interviewing the patients' caregivers and nurses, the researchers concluded that palliative care led to more comfortable deaths, and aggressive care did not prolong life.
"The more aggressive care you get, the worse your quality of life. The longer you're in hospice and receive palliative care, the better your quality of life in that last week," Prigerson said.
Some patients do hope for a miracle cure, she said.
"We're not saying these conversations are easy," she said, suggesting physicians ill-equipped for the job pass it on to those that are, such as palliative care specialists. "Patients aren't significantly more distressed after these conversations. Letting false hope persist is not really helpful."
A third study, receiving the most attention, addressed patients' feelings of abandonment by their physician once they entered hospice care. The lead author is Anthony Back, a professor of medicine at the University of Washington. USA TODAY reports:
"I think patients should expect more," says Back, an oncologist.
"I don't think it's OK for them to talk to the doctor about hospice and never hear from the doctor again," he adds. "I think it just makes that whole process harder."
Back and his co-authors interviewed 31 doctors and 55 of their patients, all of whom had incurable cancer or advanced chronic obstructive pulmonary disease and were expected to die within a year.
The Los Angeles Times and HealthDay News also offered articles on the study. Christian Sinclair at Pallimed looked at the structure hospice care and why this might occur:
The headlines place the blame squarely on the physician, but for those who work in hospice it is easy to see the many reasons why contact breaks down between physician and patient after hospice enrollment. The blame does not rest solely with the physician but more with the system in general.
There was also a study examining the reasons patients in Oregon request physician aid in dying under Oregon's Death With Dignity Act. They indicated concerns about "future illness symptoms as a leading motivator."
