27 Jan Physicians Choose Less Aggressive Care At Their Own End of Life
MedicalResearch.com Interview with:
Joel Weissman, PhD, Deputy Director and
Zara Cooper, MD, MSc Associate Surgeon
Center for Surgery and Public Health
Brigham and Women’s Hospital
Medical Research: What is the background for this study? What are the main findings?
Response: A major priority for providers of end-of-life care is balancing the intensity of a patient’s treatment with quality of life. Previous studies have looked at the intensity of end-of-life care for the general population, but not whether physicians, the group most familiar with end-of-life care, receive more or less intense end-of-life care compared to non-physicians.
Research from the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital found that for 3 of 5 end-of-life care intensity measures, physicians received significantly less intensive end-of-life care than the general population. The findings are published in the January 19, 2016 issue of JAMA, in a special themed issue focusing on end-of-life care.
The analysis included non-health maintenance organization Medicare beneficiaries aged 65 years or older who died between 2004 and 2011 in Massachusetts, Michigan, Utah, and Vermont, and was based on availability of electronic death records and ability to link to Medicare. Researchers used data from these records to look at 5 validated measures of end-of-life care intensity during the last 6 months of life: surgery, hospice care, intensive care unit (ICU) admission, death in the hospital, and expenditures. They then compared these measures between physicians and the general population (excluding other health care workers and lawyers), physicians vs. lawyers, who are presumed to be socioeconomically and educationally similar, and lawyers vs. the general population. There were 2,396 deceased physicians, 2,081 lawyers, and 666,579 people included in the analysis.
Overall, physicians were less likely to die in a hospital compared with the general population (27.9 percent vs. 32 percent, respectively), less likely to have surgery (25.1 percent vs. 27.4 percent), and less likely to be admitted to the ICU (25.8 percent vs. 27.6 percent). Physicians were less likely to die in a hospital compared to lawyers (27.9 percent vs. 32.7 percent, respectively), but did not differ significantly in other measures.
Medical Research: What should clinicians and patients take away from your report?
Response: Patients often ask their doctors what they would do or what they would choose for their own family members. This research could have a significant impact on the way that health care professionals communicate with patients and family members about end-of-life care options.
More broadly speaking, the findings provide a form of doctor testimonial recommending less aggressive end-of-life care and highlight the need for economic and human resources to support home deaths.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Additional research is needed to explore how complex decision-making processes and satisfaction with end-of-life care are related to these findings, and to see if the results found in this analysis will hold true in other states, once data becomes available.
Medical Research: Is there anything else you would like to add?
Response: This study is especially relevant because it comes at a time when Medicare has agreed to compensate doctors for the time they spend counseling patients about end-of-life care decisions.
Joel Weissman, PhD, Deputy Director and, & Zara Cooper, MD, MSc (2016). Physicians Choose Less Aggressive Care At Their Own End of Life