Historically, efforts to improve end-of-life care have focused primarily on patients with cancer. But few studies have looked at the quality of end-of-life care for patients with other serious illnesses, such as lung, kidney or heart failure or dementia. In a study of patients who died at 146 inpatient facilities within the Veteran Affairs health system, a research team led by investigators from Brigham and Women's Hospital has found that family-reported end-of-life care was significantly better for patients with cancer or dementia than for patients with other serious illnesses. The team's findings were presented today at AcademyHealth's Annual Research Meeting and simultaneously published in JAMA Internal Medicine.
"We need to broaden our attention to improve the quality of end-of-life care for all patients, not just those with cancer or dementia," said lead author Melissa Wachterman, MD, MPH, MSc, an assistant professor of medicine at Harvard Medical School and a physician both in the Department of Psychosocial Oncology and Palliative Care at Dana-Farber/Brigham and Women's Cancer Center and at VA Boston Healthcare System. "Our study shows that while there is room for improvement in the quality of end-of-life care for all patients, this is particularly true for patients dying of heart failure, chronic lung disease and renal failure."
The study examined medical records and family surveys for more than 34,000 patients who died in the VA health system between 2009 and 2012. The researchers found that patients with end-stage renal disease, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease) and frailty were far less likely to receive palliative care consultations than patients with cancer or dementia. Approximately one-third of these patients died in the intensive care unit, more than double the rates for those with cancer or dementia, and they were less likely to have do-not-resuscitate orders.
In general, the research team found that patients who had been seen by a palliative care doctor - a physician who specializes in symptom management and support around medical decision-making for seriously-ill patients -received better end-of-life care, according to their families.
"Increasing access to palliative care at the end of life may improve the quality of end-of-life care for those with heart, lung, and kidney diseases - a group that is rapidly growing with the increasing number of aging Americans dying of these conditions," said Wachterman.
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Funding for this work was provided by the National Palliative Care Research Center Junior Faculty Career Development Award, the National Institute on Aging and the Department of Veteran Affairs, Veterans Health Administration.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 3,000 researchers, including physician-investigators and renowned biomedical scientists and faculty supported by nearly $666 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.
Journal
JAMA Internal Medicine