News in brief - Feb. 20, 2012

Most cancer patients get end-of-life care talks late

Nearly three-quarters of patients with stage IV lung or colorectal cancer have end-of-life care discussions with physicians, but most of those talks come later than they should, said a study of nearly 2,200 patients published Feb. 7 in Annals of Internal Medicine (www.annals.org/content/156/3/204.abstract).

Nearly 90% of the patients who died during the two-year study period had at least one talk about end-of-life care, according to family members or other surrogates interviewed by researchers in Boston, Los Angeles and Toronto. Of the discussions documented in patient records, most occurred in the hospital.

Oncologists documented end-of-life care talks with less than 30% of their patients. Typically, the discussions happened less than five weeks before patients died. These discussions, which help determine how aggressively to pursue curative therapy compared with palliative and hospice care, should happen before patients are hospitalized and involve oncologists, the study said.

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Study warns against overemphasizing patient satisfaction

Placing too much importance on patient satisfaction measures could lead to higher health care costs and poorer clinical outcomes as physicians seek to appease patients with more discretionary services, says an Archives of Internal Medicine study published online Feb. 13.

Researchers analyzed 2000 to 2007 Agency for Healthcare Research and Quality data on 51,946 adult patients. Patients who reported higher levels of satisfaction with their medical care were less likely to go to the emergency department. But those patients were more likely to be hospitalized, took more medications and had higher health expenditures compared with less-satisfied patients.

Because patient satisfaction is linked with discretionary care, overemphasizing patient satisfaction could have unintended adverse effects on utilization, expenditures and outcomes, the study said.

"While most Americans may accurately assess how well their washing machines, their hairdressers or even their airlines are performing, their evaluations of their physicians and health care interventions may have limited viability," Brenda E. Sirovich, MD, assistant professor of medicine at Dartmouth Medical School, said in a commentary on the study (archinte.ama-assn.org/cgi/content/abstract/archinternmed.2011.1662).

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