Cj Arlotta | January 19, 2016
There are some who believe that the United States provides the worst end-of-life care in the world, but this view — based purely on personal anecdotes, according to others — is being challenged by a new report.
Researchers from the Perelman School of Medicine at the University of Pennsylvania and colleagues concluded that the United States has the lowest proportion of deaths in the hospital in the last six months of life among other countries reviewed. More than 50% of patients died in the hospital in Belgium and Canada. Thirty-eight percent of patients died in the hospital in England, Norway and Germany. Patients died in the hospital 29% of time in the Netherlands and 22% of the time in the United States.
“I think many people have an experience — either of a loved one or a friend, or something they’ve heard from a colleague — of a dying patient admitted to the ICU, and what feels like futile chemotherapy at the end,” Ezekiel J. Emanuel, chairperson of the Department of Medical Ethics and Health Policy at the Perelman School of Medicine, University of Pennsylvania, said in an email. “Those experiences, even if not the majority, are very salient and give the sense that care is too high tech and too impersonal, and [that] the patient is not at home when they die,” he said.
Published in JAMA, the report compares end-of-life care practices for patients dying with cancer in seven countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the United States. The study’s researchers reviewed data from 2010 to 2012 and compared the site of death, treatments, and care used for 389,073 patients. They also examined hospital expenses during the last six months of life.
Spending on end-of-life care for hospital care in the last six months of life in Canada and Norway: $21,840 and $19,783 per patient, respectively. The United States ranked on the higher end of the scale with $18,500. Belgium, England and the Netherlands were lower at $15,699, $9,342 and $10,936, respectively.
The United States performs poorly in other areas of end-of-life care, the study’s findings reveal. More than 40% of patients who die with cancer are admitted to the ICU in the last six months of life. This is more than twice that of any other country in the report.
Additional research on diseases other than cancer is needed, Emanuel said. He’d also like to see a more detailed analysis on the full range of costs (this includes both outpatient costs and services uses). Understanding how patients and their families perceive the quality of end-of-life care should also be a priority.
“What [the United States does] well is few hospitalizations and few people actually dying in the hospital. What we need to do is focus on providing ‘universal palliative care’ to all dying patients as a default,” Emanuel said.
Source: Forbes