Studies Investigate Health Care at End of Life

Feelings of abandonment, influence of communication and race on costs, among findings

14 mar 2009-- End-of-life health care may be associated with feelings of abandonment, and its associated costs are lower after physician-patient communication but higher among minorities, according to a series of studies published in the Mar. 9 issue of the Archives of Internal Medicine.

Anthony L. Back, M.D., of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues interviewed 55 terminally ill patients, along with their physicians and caregivers. Two themes were identified through these interviews: a loss of continuity between the patient and physician contributed to concerns of abandonment prior to death, and a lack of closure resulting in feelings of abandonment among patients and families at the time of death or after. Linda Ganzini, M.D., of the Portland Veterans' Affairs Medical Center in Portland, Ore., and colleagues found that worries of future physical discomfort and loss of self-sufficiency are important motivations for considering physician aid in dying among 56 Oregonians surveyed.

Baohui Zhang, of Harvard Medical School in Boston, and colleagues report that patients with advanced terminal cancer who had an end-of-life conversation with their physician had significantly lower health care costs during their final week of life compared with those that did not ($1,876 versus $2,917, respectively). Higher costs in that final week were significantly associated with a worse quality of death. Amresh Hanchate, Ph.D., of the Boston University School of Medicine, and colleagues found that end-of-life costs were 32 percent and 57 percent higher for blacks and Hispanics, respectively.

"At life's end, black and Hispanic decedents have substantially higher costs than whites. More than half of these cost differences are related to geographic, sociodemographic and morbidity differences," Hanchate and colleagues write.

An author of the final study reports a relationship with DxCG Inc., whose company's software was used to measure morbidity burden.

Abstract - Back
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Abstract - Ganzini
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Abstract - Zhang
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Abstract - Hanchate
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