Study: End-of-life care varies based on physician discomfort, not patients' wishes

End-of-life care for cancer patients varies greatly among hospitals, largely due to physicians' discomfort handling patients' end of life wishes, according to a study published in Health Affairs.

The study, led by Nancy Keating, MD, MPH, professor of health care policy and medicine Harvard Medical School in Boston, MA, looked at factors contributing to large variations  in end-of-life care spending for cancer patients at hospitals. To identify these contributors, Dr. Keating and her team analyzed data through surveying patients wishes and that of their doctors beliefs.

Among patients ages 65 and up diagnosed with lung or colorectal cancer between 2003-05, 1,132 died before 2013. Patients enrolled in fee-for-service Medicare had average expenditures of $13,663 in the last month of their life, according to the study.

The researchers also surveyed physicians between 2003 and 2005. Physicians in higher-spending areas reported less comfort and knowledge of treating dying patients and held less positive attitudes toward hospice, when compared with lower-spending areas.

“We really can discount the idea that high-spending areas are responding to patient demand,” Dr. Keating told STAT.

These attitudes can influence a physicians' ability to treat their patients and how they choose their care. The study also illustrated physicians in higher-spending areas were less likely to enroll themselves in hospice if diagnosed with a terminal disease.

"I've always had the idea that most doctors think really highly of hospice, and would certainly want to enroll in hospice themselves if they were terminally ill," Dr. Keating told STAT.

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