Patients with advanced cancer who reported discussing their end-of-life wishes with their doctor underwent less aggressive treatment in their final week of life, resulting in lower healthcare costs and a more peaceful death, according to a study published in the Archives of Internal Medicine.1
Terminally ill cancer patients are coping with a multitude of issues including physical pain and suffering, as well as saying goodbye to loved ones. End-of-life palliative care is important for terminally ill cancer patients in order to ease their pain and suffering as they approach their deaths; however, advanced directives and living wills are becoming increasingly common as more patients opt not to receive intensive, life-sustaining end-of-life care.
Choosing end-of-life care is a deeply personal and often difficult decision. End-of-life care is costly and also can be physically uncomfortable for the patient. The more intensive end-of-life treatments, such as tube feeding and ventilator support, contribute significantly to the rising cost of healthcare in the United States. Some research has indicated that patient–physician discussions about end-of-life care are associated with lower rates of intensive treatments.
Researchers in a multicenter study sponsored by the National Institutes of Health (NIH) evaluated 603 patients with advanced cancer to determine the factors that affected the intensity of end-of-life care. At baseline, 31.2% of patients reported discussing their end-of-life wishes with their physician. In the final week of life, the aggregate cost of healthcare for patients who had end-of-life discussions with their physicians was $1,876 compared with $2,917 for those who did not. Furthermore, the patients who had the end-of-life discussions and the lower costs also experienced a more peaceful death.
The researchers concluded that patients “who reported having end-of-life discussions with physicians had significantly lower healthcare costs in their final week of life. Higher costs were associated with worse quality of death.”
1 Zhang B, Wright AA, Huskamp HA, et al. Health care costs in the last week of life. Associations with end-of-life conversations. Archives of Internal Medicine. 2009; 169: 480-488.
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