End-of-Life Discussions Lead to Greater Hospice Use, Less Aggressive Care
Jennifer W. Mack, MD, MPH, Dana-Farber Cancer Institute, Boston, MA, and colleagues sought to determine whether earlier end-of-life discussions with patients who have incurable cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system-based prospective cohort study, led to less aggressive care near death. The main outcome measure was the aggressiveness of end-of-life care received.
Of the 1,231 patients with stage IV lung or colorectal cancer in the Consortium who had survived at least 1 month but who had died during the 15-month study period, nearly half had “received at least one marker of aggressive EOL care, including chemotherapy in the last 14 days of life (16%), intensive care unit care in the last 30 days of life (9%), and acute hospital-based care in the last 30 days of life (40%),” they reported.
Those less likely to receive aggressive measures at end-of-life were patients who had end-of-life discussions with their physicians before the last 30 days of life. This included less chemotherapy (P=0.003), less acute care (P<0.001), or any aggressive care (P<0.001). “Such patients were also more likely to receive hospice care (P<0.001) and to have hospice initiated earlier (P<0.001),” Dr. Mack noted.
“Aggressive care is not necessarily wrong for individuals at end-of-life; it may fit with the preferences of select patients who want to pursue life prolongation at any cost,” they wrote. “But most patients who recognize that they are dying do not want such care. Evidence suggests that less aggressive care is also less costly and less burdensome for surviving family members. Given the many arguments for less aggressive end-of-life care, earlier discussions have the potential to change the way end-of-life care is delivered for patients with advanced cancer and help to assure that care is consistent with patients' preferences.”