February 05, 2013|By Melissa Healy, Los Angeles Times
For Americans with a terminal diagnosis, death increasingly comes in the places and ways they say they want it — at home and in the comfort of hospice care.
But for a growing number of dying patients, that is preceded by a tumultuous month in which they endure procedures that are often as invasive and painful as they are futile.
New research finds that the proportion of Medicare patients dying in hospice care nearly doubled from 22% in 2000 to 42% in 2009, an apparent bow to patients' overwhelming preference for more peaceful passings free of heroic measures. At the same time, though, many of those patients were treated aggressively until days before death seemed inevitable.
Based on the medical and death records of almost 850,000 Medicare patients, the study, published in Wednesday's edition of the Journal of the American Medical Assn., paints a picture of increasing commotion in the final weeks of patients' lives.
The patients in the analysis all suffered from the end stages of chronic diseases such as cancer, chronic obstructive pulmonary disease or dementia. But thousands of them endured multiple hospitalizations and treatments before receiving care aimed solely at making their final days comfortable.
During the decade studied, the proportion of patients who spent part of their last month in an intensive care unit grew from 24% to 29%, and the percentage who were hooked to a ventilator rose from 8% to 9%. Among dying patients, the median number of disruptive moves — for example, from nursing home to hospital, from hospital to hospice, from rehabilitation facility to home — grew from 2.1 to 3.1. Among those who spent their final days in a hospice program, 28% were there for under four days.
"I suspect this is not what patients want," said Dr. Joan Teno, a palliative care physician and professor of health services policy and practice at Brown University, who led the study.
But for a growing number of dying patients, that is preceded by a tumultuous month in which they endure procedures that are often as invasive and painful as they are futile.
New research finds that the proportion of Medicare patients dying in hospice care nearly doubled from 22% in 2000 to 42% in 2009, an apparent bow to patients' overwhelming preference for more peaceful passings free of heroic measures. At the same time, though, many of those patients were treated aggressively until days before death seemed inevitable.
Based on the medical and death records of almost 850,000 Medicare patients, the study, published in Wednesday's edition of the Journal of the American Medical Assn., paints a picture of increasing commotion in the final weeks of patients' lives.
The patients in the analysis all suffered from the end stages of chronic diseases such as cancer, chronic obstructive pulmonary disease or dementia. But thousands of them endured multiple hospitalizations and treatments before receiving care aimed solely at making their final days comfortable.
During the decade studied, the proportion of patients who spent part of their last month in an intensive care unit grew from 24% to 29%, and the percentage who were hooked to a ventilator rose from 8% to 9%. Among dying patients, the median number of disruptive moves — for example, from nursing home to hospital, from hospital to hospice, from rehabilitation facility to home — grew from 2.1 to 3.1. Among those who spent their final days in a hospice program, 28% were there for under four days.
"I suspect this is not what patients want," said Dr. Joan Teno, a palliative care physician and professor of health services policy and practice at Brown University, who led the study.
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Quiet deaths don't come easy
2 comments:
"First, do no harm!"
Why should obviously terminal patients be tortured with useless treatment, especially if they want to die in peace?
I think there is alot more of this going on than we know.
Thank you for posting, NASGA.
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