Atul Gawande has written yet another excellent article in the New Yorker. This one about end of life care. In the debate surrounding health reform, many politicians hijacked the serious discussion of end-of-life decisions and decisions to use non-invasive medical treatment were termed death panels. But end-of-life decisions merit further investigation. Not only can giving patients end-of-life treatment options lower cost, but it can also improve the patient remaining quality of life. For instance:
“Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression.”
One reason that palliative care has not been adopted by more patients is that most hospice facilities compel patients to agree to forego more intensive services. One innovative program convinced more terminal patients to use hospice facilities by allowing access to more intensive treatment while in hospice care.
“In late 2004, executives at Aetna, the insurance company, started an experiment. They knew that only a small percentage of the terminally ill ever halted efforts at curative treatment and enrolled in hospice, and that, when they did, it was usually not until the very end. So Aetna decided to let a group of policyholders with a life expectancy of less than a year receive hospice serviceswithout forgoing other treatments…A two-year study of this “concurrent care” program found that enrolled patients were much more likely to use hospice: the figure leaped from twenty-six per cent to seventy per cent. That was no surprise, since they weren’t forced to give up anything. The surprising result was that they did give up things. They visited the emergency room almost half as often as the control patients did. Their use of hospitals and I.C.U.s dropped by more than two-thirds. Over-all costs fell by almost a quarter.”
NPR’s Fresh Air also has an interview with Dr. Gawande.