Researchers advocate improvements in end-of-life care

An outcomes study led by Alexi Wright, MD, MPH, a researcher and a gynecological oncologist in the Susan F. Smith Center for Women’s Cancers at Dana-Farber, surveyed families of older patients who had died of advanced lung and colorectal cancer, asking what factors were associated with ‘excellent’ end-of-life care for their loved ones.
The families were more likely to assess care as excellent – by relatively large margins – when:

  • the patient had hospice care for more than three days, compared with fewer than three days or none;
  • the individual wasn’t admitted to an intensive care unit (ICU) in the last 30 days of life;
  • the patient died at home or some other location outside the hospital, such as a hospice facility.

‘Our study findings are a powerful argument for the importance of advance care planning,’ Wright said. ‘The more information patients have, the more likely they are to receive the kind of medical care they want near death. And patients’ deaths influence family members’ perceptions of their quality of care.’
Wright reported that end-of-life care could be of higher quality if there are efforts to enroll patients in hospice earlier – not when death is imminent – and to avoid intensive care unit admissions in the final weeks.
Terminally ill patients should have the legal option to choose physician-assisted death, even if – as is often the case in USA States where it is legal- they don’t use it, wrote Susan Block, MD, founding chair, Department of Psychosocial Oncology and Palliative Care at Dana-Farber and two other authors of a ‘Viewpoint’ opinion piece.
Patients nearing the end of life want control over their bodies and their lives as ‘a small measure of self-preservation,’ they noted. Such individuals can gain peace of mind when they have a ‘back-up’ plan, they added.
‘When physicians are willing to explore and work with a patient requesting physician-assisted death, patients can experience substantial benefits that are more apparently under an open legal process,’ said the authors.

Dana-Farber Cancer Institute