End of Life Care Less Costly When Physicians Communicate
Posted Mar 19 2009 6:24am
In a follow up to yesterday’s guest post about end of life care and the engagement of health care providers comes this. The March 9 issue of Archives of Internal Medicine reports that patients with advanced cancer who discuss end-of-life care with their physicians appear to have lower health care costs in the final week of life than those who do not.
As many know, most medical costs occur at the end of life. Almost one-third of Medicare expenditures are attributable to the 5 percent of beneficiaries who die each year, and about one-third of expenses in the last year of life are spent in the final month. Most of these costs result from life-sustaining care, including resuscitation and mechanical ventilation.
The study found that in the final week of life, patients who reported having end-of-life discussions with their physicians had average aggregate healthcare costs of $1,876, compared with $2,917 for patients who did not. Caregivers who were interviewed after patients’ deaths reported that those with higher costs also had a worse quality of death.
So I am not saying that physicians and health care staff should sustain relationships with their patients after all hope is exhausted because it might imply lower health care costs. They should stay engaged because it is the right thing to do. That said some of the end of life decisions should be made by all of us well before we get sick. That requires having a living will and assigning durable medical power of attorney.
By having your wishes spelled out you save your loved ones from anguish and the guilt of trying to sustain life when all hope is gone. In many cases as this study shows that prolonging can actually do more harm than good.