Families Have Distinct Preferences for End-of-Life Care

The results of this study underscore the importance of advance care planning in improving the quality of care that patients receive at end-of-life.

Alexi A. Wright, MD, MPH

A claims-based retrospective study in a Medicare population has found that family members of patients who died of cancer were more likely to report the patient’s end-of-life (EOL) care as “excellent” if hospice care was longer than 3 days, if patients were not admitted to the intensive care unit (ICU) within the last 30 days of death, or if the patient died outside of a hospital setting.

The results of this study underscore the importance of advance care planning in improving the quality of care that patients receive at EOL, ensuring that the treatment or care the patient receives meets their goals of care.

The study included analysis of interviews with 1146 bereaved family members of Medicare patients with advanced lung or colorectal cancer who had died by 2011. The study examined claims-based quality measures of aggressive EOL care, which included ICU admission or repeat hospitalizations or emergency department visits during the last 30 days of life, chemotherapy administered in the last 2 weeks of life, no hospice of less than 3 days of hospice, and death in the hospital.

A slight majority of family members (51.3%) reported EOL care as excellent. Additionally, about 59% of family members were happy if hospice care extended beyond 3 days, but 45% were unhappy if the patient was in the ICU 30 days prior to death. More than 42% of family members of patients who died in the hospital setting reported being unhappy with EOL care.

The authors concluded that earlier hospice enrollment, avoidance of ICU admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better EOL care, and that their findings are supportive of advance care planning consistent with the preferences of patients.

“Our study findings are a powerful argument for the importance of advance care planning,” lead study author Alexi A. Wright, MD, MPH, of Harvard Medical School and Dana-Farber Cancer Institute said in a statement.

“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.

Wright AA, Keating NL, Ayanian JZ, et al. Family perspectives on aggressive cancer care near the end of life. JAMA. 2016;315(3):284-292.

Surabhi Dangi-Garimella, PhD, is a writer and editor for the American Journal of Managed Care, Evidence-Based Oncology. Read more at AJMC.com.