Seven years ago, my 78-year old mother lay dying from lymphoma in her New York City hospital room. Her body was giving up its fight for life after four long years of aggressive chemotherapy treatments. With faltering vital signs, it was clear this was not just one of the many battles she had fought to stave off the encroaching disease. With her organs failing, my mother rapidly transitioned from ill at home to dying in the hospital, with no time to obtain hospice care. Gathered together, my family and I kept vigil by my mother’s bedside.
Although it was clear my mother was dying, doctors doing rounds continued to bombard my three brothers and me with offers of tests and procedures. My father, overwhelmed with emotion and fear, would have agreed to all the young residents proffered if my twin brother, an MD, had not intervened.
With my brother’s guidance, we knew to ask if there was any benefit to additional testing and if the findings would have an impact on my mother’s prognosis. The attending doctors conceded that aggressive interventions would not reverse my mother’s decline. My family and I determined to use the time remaining to keep my mother comfortable and to say goodbye.
Echoing this real life experience is a longitudinal study released in April by the Dartmouth Atlas Project on trends and variation in end-of-life care. This geographically diverse report found an increase in the intensity of care for Medicare patients that were hospitalized and chronically ill. According to the analysis, hospice care is on the rise, but so is aggressive in-hospital care. Medicare patients diagnosed with severe chronic illnesses had more physician visits, especially with specialists, and spent more time in intensive care units.
This story isn’t new. Increasingly, studies are finding that in America, we continue to accept — even push for — aggressive, technology-heavy care even though it may do nothing for our health and undermine the short time we have left.
“In addition to its effects on patients’ quality of life, unnecessarily aggressive care carries a high financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last years of life,” said David C. Goodman, M.D., M.S., lead author and co-principal investigator for the Dartmouth Atlas Project and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. “It may be possible to reduce spending, while also improving the quality of care, by ensuring that patience preferences are more closely followed,” he said. Continue reading