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Care costs less when patients discuss end-of-life with doctors

E-mail | Print | Comments () Posted by Gideon Gil March 9, 2009 04:00 PM

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By Liz Kowalczyk, Globe Staff

Cancer patients who talked to their doctors about end-of-life care had significantly lower health care costs in the week before they died, according to researchers at Dana-Farber Cancer Institute and several other institutions.

In a study of more than 600 patients with advanced cancer in Boston and other cities, 188 patients, or 31 percent, reported having discussions with their doctor about "any particular wishes you have about the care you would want to receive if you were dying."

Those patients had 36 percent lower costs in their final week of life than patients who did not report discussing end-of-life issues with their physicians; $1,876 compared to $2,917, respectively.

Each patient was interviewed an average of six months before they died, and followed by researchers until their death. Researchers reviewed patients' medical records to obtain information about their care during the last week of life, such as whether they spent the week in an intensive care unit or in hospice, and whether they were on mechanical ventilation and were resuscitated.

Researchers said they adjusted for factors such as patients' treatment preferences.

Holly Prigerson, of Dana-Farber, senior author of the paper in Archives of Internal Medicine, said that patients who talked to their doctors probably had a more realistic sense of their illness and therefore made more informed choices about treatment.

"It's most likely that patients who had end-of-life discussions recognized they were terminally ill; if you realize you are not curable, why try to prolong an ultimate demise?'' she said. "It helps patients appreciate and have more realistic goals for their care.''

Patients who reported discussing end-of-life issues with their doctors experienced less physical distress in the last week of life, but the two groups did not differ on psychological distress or survival time.

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White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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