MONDAY, June 28 (HealthDay News) -- U.S. hospitals need to do
more to improve care for dying patients, researchers say.
Tending to patients in their last year of life accounts for 10
percent to 12 percent of the U.S. health care budget and 27 percent
of Medicare costs, according to background information in the study
published in the June 28 issue of the
Archives of Internal Medicine.
"Despite this intensive resource use, studies suggest that when lifesaving treatments are unsuccessful, hospitalized patients often die with distressing symptoms. Studies of patients who died in hospital find that pain, dyspnea [trouble breathing] and restlessness or agitation are prevalent before death. Furthermore, persons dying in the hospital often receive burdensome care immediately before death that may not match patient preferences," Dr. Anne M Walling, of the University of California, Los Angeles, and colleagues wrote in a news release from the journal.
In the study, Walling's team analyzed the medical records of 496
adult patients, average age 62, who were hospitalized for at least
three days before they died. The care of the patients, who were in
a university medical center recognized for providing intensive care
to seriously ill people, was assessed using 13 quality
The researchers found that more than half of the patients were
admitted to hospitals with end-stage disease, one-third had to be
taken off mechanical ventilation before death, and 15 percent died
while receiving cardiopulmonary resuscitation (CPR).
Patients received recommended care for 70 percent of the quality
indicators. For example, pain assessments were performed 94 percent
of the time, and treatment for pain (95 percent) and breathing
difficulties (87 percent) was given as recommended.
However, the researchers found that follow-up for distressing
symptoms was less rigorous than initial assessments, and only 29
percent of patients who had ventilation tubes removed before death
were evaluated for breathing difficulties.
"Even after 48 hours in the intensive care unit or on the ventilator, more than half of patients had no medical record documentation about goals of care or an attempt to pursue the topic," the study authors wrote.
"Although medical care should be tailored to achieve patients' goals and prior work shows that patients' preferences depend on prognosis, medical care cannot be guided by informed choices absent communication about current clinical status and what course is likely to follow," the authors added.
"Deficits in communication, dyspnea assessment, implantable cardioverter-defibrillator deactivation and bowel regimens for patients prescribed opioids should be targeted for quality improvement. The findings suggest much room for improvement in treating patients dying in the hospital," they concluded.
The U.S. National Institute on Aging offers advice on
finding end-of-life care.