Discussing end of life care lowers cost

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Interesting reading: Discussing end-of-life care lowers cost: U.S. study

Terminally ill patients who talk over end-of-life treatments with their doctors spend less money and do not die any sooner but die more peacefully than those receiving aggressive care, researchers said on Monday.

Patients who have the discussion tend to opt for cheaper palliative care in a hospice or at home rather than costly treatments like emergency resuscitation, ventilators to breathe for them and movement to a hospital's intensive care unit.

The goal of palliative care is to relieve suffering rather than to halt progression or cure the disease.

If half of the estimated 566,000 American adult cancer patients who died in 2008 had the end-of-life discussion, the projected savings would conservatively be $77 million, according to a report published in the Archives of Internal Medicine.

U.S. policymakers are hoping to find ways to rein in soaring healthcare costs, and researchers said end-of-life care merits a close look.

The one in 20 Medicare patients who die each year use up almost one-third of expenditures by Medicare, the government health insurance program for the elderly and disabled.

One third of expenses in the last year of life are spent in the final month, according to the report, with aggressive treatments in the final month accounting for 80 percent of those costs.

"This is a waste of money ... The real cost differences could be substantial," said Holly Prigerson of Dana-Farber Cancer Institute at Harvard, who helped perform the study.

The researchers interviewed 603 terminally ill cancer patients and estimated conservatively that those who spoke with their doctors about end-of-life care incurred $1,876 in medical costs in their final week of life, compared to $2,917 for those who did not.

After interviewing the patients' caregivers and nurses, the researchers concluded that palliative care led to more comfortable deaths, and aggressive care did not prolong life.

"The more aggressive care you get, the worse your quality of life. The longer you're in hospice and receive palliative care, the better your quality of life in that last week," Prigerson said.

Some patients do hope for a miracle cure, she said.

"We're not saying these conversations are easy," she said, suggesting physicians ill-equipped for the job pass it on to those that are, such as palliative care specialists. "Patients aren't significantly more distressed after these conversations. Letting false hope persist is not really helpful."

Another study published in the journal by Boston University researchers found that black and Hispanic Medicare patients incurred higher costs than whites in their final six months.

The intensive end-of-life treatments provided to minorities reverses the lifetime pattern where they received less medical care than whites, according to the report.


Researcher Amresh Hanchate and colleagues speculated that lack of familiarity or distrust of the medical system, as well as religious beliefs, could help account for the gap.

A third study showed patients fear their doctors abandon them as death approaches.

"Physicians are aware of this fear and attempt to address it with reassurance or continuity strategies. Yet, as death approaches, some patients and families may feel abandoned nonetheless," wrote Dr. Anthony Back of Fred Hutchinson Cancer Research Center and the University of Washington, Seattle.