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Patients should decide what the end of life is like, study says

March 20, 2013|By Mary MacVean
  • Britain's Catherine, duchess of Cambridge, talks to a group of residents of St. Andrews Hospice this year.
Britain's Catherine, duchess of Cambridge, talks to a group of residents… (Associated Press )

Finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars, UCLA researchers said Tuesday.

“You can improve care while reducing costs by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,” Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, said in a statement.

Bergman and colleagues wrote an article advocating for patient-centered care at the end of life in the journal JAMA Surgery.

People who are dying often receive care that is poorly coordinated and not in line with the patient’s values or goals, the journal authors said. That should change, they said.

Studies have shown that when a patient’s desires are taken into account, death is less likely to occur in an intensive care unit, physical distress is reduced, and death comes no sooner, they wrote.

Thirty percent of Medicare’s resources are spent each year on the 5% of recipients who die, the authors said.

Policymakers can make changes by including the importance of patient-centered care in education. “Our curricula reflect our priorities as a medical community, and we should show that we value end-of-life care by teaching it to each trainee,” the authors wrote.

Medicare also should address this issue, to make sure that aggressive care goes to people who want it but not to those who do not -- saving money and improving care. And hospital ratings of quality and safety should also take end-of-life care into account, the authors said.

“Surgeons can lead this effort: At UCLA, all urology residents are receiving education about end-of-life care, using online, problem-based, patient-centered modules,” the authors said.

Researchers are working with cancer patients being treated at the West L.A. Veterans Affairs Medical Center, determining their goals and integrating a palliative care specialist at the outset of care.

Too often, Bergman said, there has been no such discussion. “Then a lot of very aggressive treatments can occur due to inertia. Patients are placed in an intensive care unit with oxygen and feeding tubes, and that’s not always in line with their goals.”

@mmacvean on Twitter

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