Care for dying patients may sometimes be too aggressive

Experts say recent studies underscore the need to re-evaluate how end-of-life care is handled.

By Kevin B. O'Reilly, AMNews staff. Aug. 7, 2006.

Two recent studies of Medicare data suggest that medical interventions for terminally ill cancer patients and chronically ill patients at the end of life are sometimes overly aggressive and wasteful. Experts said the findings demonstrate that changing how end-of-life care is approached remains a challenge.

"These studies reinforce the point that oftentimes aggressive care at the end of life ... is still an issue," said John G. Carney, vice president of aging and end of life at the Center for Practical Bioethics in Kansas City, Mo. "This needs to be looked at from various perspectives, not just oncology."

The first study, a May online report from the Dartmouth Medical School's Center for the Evaluative Clinical Sciences, examined records of 4.7 million chronically ill Medicare enrollees who died between 2000 and 2003 and found huge variations in the volume and intensity of end-of-life care provided without accompanying quality gains.

Most telling, said the Dartmouth researchers, was that the average number of hospitalized days during the last six months of life ranged from 12.9 days per patient at the Mayo Clinic's St. Mary's Hospital to 23.9 at New York-Presbyterian Hospital. Patients who spent more time in the hospital, in intensive care units or seeing specialists did not get better results, according to the report.