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University of Pittsburgh finds that people would trade longevity for quality end-of-life care

University of Pittsburgh Medical Center

PITTSBURGH, May 19 - An overwhelming number of people surveyed would trade a longer life span in order to receive better end-of-life care, according to University of Pittsburgh researchers.

The study, published in the May issue of the journal Medical Care, used a sampling of 104 persons who took a survey based on six scenarios involving an 80-year old man who died after a one month stay in an intensive care unit (ICU).

"From our research, we found that people care a great deal about the quality of the death experience," said lead author Cindy L. Bryce, Ph.D., assistant professor of medicine and a researcher at the Center for Research on Health Care at Pitt.

On average, interviewees were willing to trade seven months of healthy life just to ensure better quality of care in the final month of life.

"We tested the importance of good care at the end of life by measuring whether people would be willing to trade life expectancy and live a shorter life for better care at the end of life. The results were overwhelming, as 75 percent said they would trade some amount of healthy life to improve the quality of end-of-life care," Dr. Bryce said.

According to Dr. Bryce, quantifying the value of end-of-life care is relevant for prioritizing care when resources are limited.

Efforts to set health care priorities might include something like a cost effectiveness analysis (CEA), which compares the costs and benefits of various health care services to determine which ones provides the most benefit relative to their costs, according to Dr. Bryce.

"Typically, quality-adjusted life years are used as the measure of benefit. But, as our paper describes, quality-adjusted life years may not do a satisfactory job in measuring the benefits of end-of-life care, which could result in end-of-life services being rated as unimportant."

Dr. Bryce said the study affirms that end-of-life care is important and that good end-of-life care includes both medical and non-medical considerations, including pain control and support for family members.

"We need to develop the right kind of measurement tools because it's not enough to simply say 'x, y and z' are all important, which has always been true of all kinds of health services. Our study begins to assess how important 'x, y and z' are," she said.

The research determines the importance of end-of-life care and improves upon previous measures such as quality-adjusted life years, which restrict the value placed on services and are therefore incapable of measuring the true importance of end-of-life care.

Also involved in the study were George Lowenstein, Ph.D., professor of economics, Carnegie Mellon University; Robert M. Arnold, M.D., professor of medicine, University of Pittsburgh; Jonathan Schooler, Ph.D., professor of psychology, University of Pittsburgh; Randy S. Wax, M.D., lecturer, interdepartmental division of critical care medicine, University of Toronto; and Derek C. Angus, M.D., M.P.H., professor of critical care medicine, medicine, and health policy and management and vice chair for research, department of critical care medicine, University of Pittsburgh.


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