No matter what care protocol a physician is following, there are likely several points in which a path diverges. When these choices arise, it is critical that physicians take the time to help patients to make informed decisions.
This topic of evidence-based vs. personalized care came up in an excellent article I read last week by Ira Byock, MD, a palliative care physician and professor at the Geisel School of Medicine at Dartmouth. His article was included as an part of a Dartmouth Institute report on trends in end-of-life cancer care.
The study found that the percentage of cancer patients who died in a hospital vs. at home while receiving hospice care varied greatly from one in eight to one in two, depending on the facility in which the patient received care. The authors argue that the finding suggests providers’, not patients’ preferences guided when to transition to hospice care.
Dr. Byock’s column eloquently explains why this finding is so concerning: Often, patients prefer living their last days at home, if they are accurately informed about their chances of survival. He writes:
“Under the influence of the more-is-better mentality, well-intentioned clinicians and loving families can inadvertently cause people to spend previous, fleeting days at the end of a long illness in hospitals and ICUs, instead of at home or other places they would rather be.”
Dr. Byock goes on to argue that care protocols must be allowed to be adjusted to reflect patient preferences.
“The solution begins with recognizing that since cancer is personal, the “best care” must be defined one person at a time. Evidence-based treatment algorithms for specific types and stages of cancer are invaluable; however, quality requires tailoring treatments and plans of care to reflect the values, preferences, and priorities of the individual living with cancer.”
Thus, if care protocols are created that call for honest conversations between the provider, the patient and family at various milestones during the treatment of an advanced illness, care protocols could actually play a role in making healthcare more personal.
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