I thought, this discussion about the pros and cons of interventional end of life care had been settled since about the 1980s/1990s. Was it not widely accepted since then that palliative care was better for and preferred by many individuals!
"The last days of people facing terminal diagnoses in the US are all-too-often filled with aggressive—and ultimately unhelpful—medical care, a recent study finds.
Researchers found that in the final 30 days of life of 146,000 older patients, most of them received “aggressive end of life care.”
Markers of such invasive care included repeated ER visits, hospitalizations, interventional cancer treatments, last-minute hospice enrollment, and death in a hospital.
Both people living at home and those living in nursing homes experienced these kinds of drastic interventions—which researchers say stem from decisions made by both caregivers and physicians.
The Quote: “Patients who received this type of aggressive care experience more pain, actually die sooner, have a much poorer quality of life at the end,” said the study’s co-author."
From the abstract:
"Importance: Nearly 10% of the 1.5 million persons residing in nursing homes (NHs) have received or will receive a diagnosis of cancer. Although aggressive end-of-life (EOL) care is common among community-dwelling patients with cancer, little is known about such patterns of care among NH residents with cancer.
Objective: To compare markers of aggressive EOL care between older adults with metastatic cancer who are NH residents and their community-dwelling counterparts.
Design, setting, and participants: This cohort study used the Surveillance, Epidemiology, and End Results database linked with the Medicare database and the Minimum Data Set (including NH clinical assessment data) for deaths occurring from January 1, 2013, to December 31, 2017, among 146 329 older patients with metastatic breast, colorectal, lung, pancreas, or prostate cancer, with a lookback period in claims data through July 1, 2012. Statistical analysis was conducted between March 2021 and September 2022.
Exposures: Nursing home status.
Main outcomes and measures: Markers of aggressive EOL care were cancer-directed treatment, intensive care unit admission, more than 1 emergency department visit or more than 1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death.
Results: The study population included 146 329 patients 66 years of age or older (mean [SD] age, 78.2 [7.3] years; 51.9% men). Aggressive EOL care was more common among NH residents than community-dwelling residents (63.6% vs 58.3%). Nursing home status was associated with 4% higher odds of receiving aggressive EOL care (adjusted odds ratio [aOR], 1.04 [95% CI, 1.02-1.07]), 6% higher odds of more than 1 hospital admission in the last 30 days of life (aOR, 1.06 [95% CI, 1.02-1.10]), and 61% higher odds of dying in the hospital (aOR, 1.61 [95% CI, 1.57-1.65]). Conversely, NH status was associated with lower odds of receiving cancer-directed treatment (aOR, 0.57 [95% CI, 0.55-0.58]), intensive care unit admission (aOR, 0.82 [95% CI, 0.79-0.84]), or enrollment in hospice in the last 3 days of life (aOR, 0.89 [95% CI, 0.86-0.92]).
Conclusions and relevance: Despite increased emphasis to reduce aggressive EOL care in the past several decades, such care remains common among older persons with metastatic cancer and is slightly more prevalent among NH residents than their community-dwelling counterparts. Multilevel interventions to decrease aggressive EOL care should target the main factors associated with its prevalence, including hospital admissions in the last 30 days of life and in-hospital death."
No comments:
Post a Comment