The results of a new JAMA study underscore the importance of advance care planning in improving the quality of care that patients receive at the end of life.
A new claims-based retrospective study in a Medicare population, published in JAMA, has found that family members of patients who died of cancer were more likely to report the patient’s end-of-life (EOL) care as “excellent” if hospice care was longer than 3 days, if patients were not admitted to the intensive care unit (ICU) within the last 30 days of death, or if the patient died outside of a hospital setting.
The results of this study underscore the importance of advance care planning in improving the quality of care that patients receive at EOL, ensuring that the treatment or care the patient receives meets their goals of care.
The study included analysis of interviews with 1146 bereaved family members of Medicare patients with advanced lung or colorectal cancer who had died by 2011. The study examined claims-based quality measures of aggressive EOL care, which included ICU admission or repeat hospitalizations or emergency department visits during the last 30 days of life, chemotherapy administered in the last 2 weeks of life, no hospice of less than 3 days of hospice, and death in the hospital.
Of the 1146 patients, 51.3% family members reported EOL care as excellent. Additionally, about 59% of family members were happy if hospice care extended beyond 3 days, but 45% were unhappy if the patients was in the ICU 30 days prior to death. More than 42% of family members of patients who died in the hospital setting reported being unhappy with EOL care.
The authors concluded that earlier hospice enrollment, avoidance of ICU admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better EOL care, and that their findings are supportive of advance care planning consistent with the preferences of patients.
“Interventions should focus more on increasing early hospice enrollment and decreasing ICU admissions and hospital deaths,” lead study author Alexi A. Wright, MD, MPH, of Harvard Medical School and Dana-Farber Cancer Institute in Boston, told Reuters. “The best way to do this is to encourage patients, physicians and family members to talk about their end-of-life wishes.”
Read more about palliative care and its value proposition from palliative care specialists and healthcare policy researchers in a special issue of Evidence-Based Oncology.