A new Rutgers School of Public Health study finds that terminally ill patients whose physicians reported feeling more comfortable making decisions on their behalf are more likely to seek experimental and aggressive treatment as a last-ditch effort before they die.
The study was the first to examine if the personal beliefs and attitudes of both patients and physicians impact end-of-life treatments that can be painful and risky.
The researchers, led by Dr. Paul Duberstein, chair of the Department of Health Behavior, Society and Policy, examined chemotherapy use and hospitalizations or emergency department visits in the last 30 days of life. The researchers found that patients of physicians who were comfortable offering biomedical interventions were more likely to receive chemotherapy and endure difficult hospitalizations in the days and weeks before dying. Patients who have unfavorable attitudes toward palliative care and those who desire unproven cancer treatments were also more likely to use these costly services. These attitudes could have detrimental impacts on their end-of-life care and prevent terminally ill patients from receiving the emotional support needed at that time.
Public opinion surveys show that most people would prefer to die peacefully at home, yet many people die in hospitals shortly after receiving these aggressive and futile treatments.
Greater research, clinical, and policy attention to patient treatment preferences and physician comfort with medical paternalism might strengthen care delivery and improve patients’ experiences at the end of life.
Co-authors include researchers from the University of Rochester, University of California-Davis, Tulane University, and Weill Cornell Medical College.Tags: Friday Letter Submission