Families of patients dying of cancer prefer end-of-life care in a hospice for their loved ones with treatment focused on providing comfort over a hospital's intensive care unit and its aggressive treatments, a new study finds.
Their perceptions of better end-of-life care involved earlier hospice enrollment, avoidance of ICU admissions within a month of death and the death occurring outside the hospital, study researchers found.
While patients with advanced-stage cancer are often treated with aggressive medical care as life ebbs, there is increasing evidence such intrusive treatments do not result in better quality of life, better outcomes or satisfactory caregiver bereavement, they report in their study appearing in JAMA.
When dying patients experienced at least three days of hospice care devoted to comfort and sustaining quality of life, 59 percent of patients' families expressed a feeling that the treatment offered was excellent, the study found.
In comparison, only 43 percent of families of patients who received little or no hospice-based care had the same feeling about their treatment.
Similarly, families of patients who were admitted to an ICU for the last month of life only thought the treatment offered was excellent 45 percent of the time, the researchers say.
The findings are a clear indication of what families would prefer, they suggest.
"Interventions should focus more on increasing early hospice enrollment and decreasing ICU admissions and hospital deaths," says lead study author Dr. Alexi Wright of Harvard Medical School and the Dana-Farber Cancer Institute in Boston.
"The best way to do this is to encourage patients, physicians and family members to talk about their end-of-life wishes," Wright suggests.
For their study, the researchers used information gathered during interviews with families of Medicare patients with advanced-stage lung or colorectal cancer after the patients' death. It was conducted as part of the Cancer Care Outcomes Research and Surveillance study.
Medical experts said that if a family and/or patient considers hospice care preferable to more aggressive hospital treatment, it should be communicated to doctors or caregivers as soon as possible.
"Don't wait for someone to suggest hospice," urges Dr. David Casarett, head of palliative care for Penn Medicine in Philadelphia. "By the time that a doctor thinks about hospice as an option, and suggests it, it's often too late."
A hospice or home hospice care may be better at providing pain or symptom management along with spiritual and emotional support, he says.
"Hospice is very good at providing that sort of support and is designed to help people remain in their homes," says Casarett.
