That hospices are becoming the "last resting places for people who've been through a high-tech tunnel" should not be surprising, said Dr. John Wennberg, a Dartmouth medical school expert on end-of-life care who was not involved in the new study.
As hospice and palliative care programs have grown in number, so too has the capacity of acute-care hospitals, he said. And healthcare usage in the United States appears to follow an "if you build it, they will come" pattern, with growing capacity helping to drive increased use of both hospitals and hospice or palliative programs.
The conventional wisdom "that if you invest in one sector, you'll reduce demand in the other is wrong," Wennberg said.
Teno agreed that the U.S. healthcare system encourages overuse of tests and procedures, often on patients who will not benefit. To force change, she said, patients need better information on whether doctors and hospitals have a good record of honoring the healthcare preferences of those at the end of life.
Physicians need to change too, Bynum said.
"We're pretty fearful of taking away hope," she said. "But my response is, 'Your hope for what? Return to full function?' In many cases, that's not achievable."