Distributed March 4, 2002
News Service Contact: Scott Turner
Study details costs of providing care inconsistent with patient wishes
A new study shows how frequently seriously ill people who crave comfort receive more-aggressive care instead. The study also details the costs and survival rates associated with this contrary care. It will appear in the Journal of the American Geriatric Society and was led by Brown Medical School researchers.
PROVIDENCE, R.I. — A new study led by Brown University researchers shows more than one-third of gravely ill patients who ask for palliative care get something else instead: life-extending treatments that often prolong their pain and suffering.
The study also finds that patients who receive more aggressive, life-prolonging care have longer survival times but incur medical costs nearly twice as high as the palliative care they originally requested.
“This is the first study to confirm anecdotal reports that many seriously ill persons who want their care to focus on comfort believe they are receiving care contrary to that preference,” said Joan M. Teno, M.D., lead author of the study.
“The findings have implications for health care costs and length of survival,” she said. “Costs are lower for those persons who report that their medical care is consistent with their preference to focus on their comfort. This provides the alluring possibility of an ethically defensible reduction in health care costs.”
Teno and colleagues studied 1,185 seriously ill people about the 10th day of their hospitalization. They found that 60 percent expressed a preference for their care to focus on comfort but 35 percent of those patients believed they received aggressive treatment instead.
Persons who wanted comfort care and who believed they got it had one-year health costs of $52,098 and a one-year survival rate of 38 percent. This compared to $92,442 for patients who said their life-extending treatment was not in accord with their preferences for palliation. This latter group had a one-year survival rate of 55 percent.
Even after adjusting the findings for disease severity, age and other factors, the researchers found that patients who wanted – but did not receive – comfort care had medical costs 1.4 times higher than patients who did.
The study appears in the March issue of the Journal of the American Geriatric Society. Teno is associate director of the Center for Gerontology and Health Care Research in the Brown Medical School.
“We have the perception that people receive more aggressive care than they want,” said Teno. “In fact many people fear that they will receive more aggressive treatment than they desire at the end of life.” Until now, little data was available to show how frequently this occurred. Multiple studies suggest physicians do not do well at predicting patient preferences for care.
In the study, patients who asked for comfort but who received life-extending care did not object to this inconsistency, Teno said. “We do not know why people did not object, nor why they did not fight the care that they received,” she said.
Of the 40 percent of patients in the study who expressed a preference for life-extending treatment, 86 percent said they received care consistent with that request.
Robert Wood Johnson Foundation and the Agency for Health Care Policy and Research funded the study.
The other authors include Elliott S. Fisher, M.D., Dartmouth Medical School and Veterans Affairs Hospital, White River Junction, Vt.; Mary Beth Hamel, M.D., Beth Israel Deaconess Medical Center; Kristen Coppola, former post-doctoral fellow, Center for Gerontology and Health Care Research; and Neal V. Dawson, M.D., Case Western Reserve University.
The authors call for further studies on tailoring medical care to patients’ treatment goals, in particular the development of quality indicators that examine whether medical care at the end of life is based on patients’ treatment preferences.