Providing information can ease end-of-life experience, study finds
By Ed Edelson
HealthDay Reporter
TUESDAY, July 12 (HealthDay News) -- Giving straightforward information to elderly people facing death in nursing homes makes them more likely to enter hospices, where they can receive better care in the last days of their life, a new study finds.
"Over the last 10, 20, 30 years we have tried all sorts of high-tech and expensive interventions to improve end-of-life care," said Dr. David Casarett, director of the palliative care clinic at the Philadelphia Veterans Affairs Medical Center, who led the study. "But if you just get people talking, you get more people into the hospice sooner, and people who have these conversations are more satisfied with the end-of-life care they receive."
The study started with Casarett and his colleagues interviewing nursing home residents or the people who made medical decisions for them, to help identify those who would benefit from entering hospices -- facilities specializing in end-of-life care.
Of the 205 nursing home residents who were so selected, 107 were given an informational visit describing hospice care, and 98 received usual care, according to a report in the July 13 issue of the Journal of the American Medical Association.
One of every five people who got the informational visit entered a hospice within the next 30 days, compared to only one person among those who received usual care.
Eventually, 25 percent of those getting hospice information entered hospices, compared to 6 percent of those who did not.
The people who entered hospices had fewer acute care hospital admissions and spent fewer days in the hospital, the researchers noted. Most important, family members of those who entered hospices rated the quality of end-of-life care higher -- 4.1 on a scale of five, compared to 2.5 for those remaining in nursing homes, the study found.
It's true that many people nearing the end of life may not want to have these discussions for a variety of reasons, Casarett said. On the other hand, "many people want to have these discussions but don't know how," he said.
Previous studies have shown that "a lot of people are thinking about hospices as something that can help them and are waiting for their physicians to start these discussions," he said.
Doctors and nurses often do have such conversations with patients, "but what we are not doing is having these conversations in a systematic way," Casarett. "I hope that this study will help change that."
According to background information for the article, "At least one in four Americans dies in a nursing home, and considerable evidence indicates that nursing home residents do not receive optimal end-of-life care." Approximately 25 percent of residents with daily cancer pain receive no pain medications, and residents are often transferred to an acute care setting to receive aggressive treatment in the last weeks of life. Families often express dissatisfaction with the end-of-life care their relative receives in nursing homes.
Nursing home residents receiving hospice care are more likely to receive better pain management, have their pain assessed and have lower rates of inappropriate medications and physical restraint use than patients who do not receive hospice care. Despite its benefits, however, only one in every four nursing home residents enrolls in hospice care before death, according to the researchers.
"As Americans spend more time in nursing homes near the end of life, it will become increasingly important to emphasize simple, low-cost interventions like this one [hospice care] that can help to ensure that residents and their families have access to the best possible quality of care," the study authors wrote.
Dr. Perry G. Fine is vice president for medical affairs at the National Hospice and Palliative Care Organization, in Alexandria, Va. He said, "What this study confirms is that if you institute conversations with people, they will more often choose hospice care. And they will end up far more satisfied than those who don't."
SOURCES: David Casarett, M.D., director, palliative care division, Philadelphia Veterans Affairs Medical Center; Perry G. Fine. M.D., vice president for medical affairs at the National Hospice and Palliative Care Organization, Alexandria, Va.; July 13, 2005, Journal of the American Medical Association
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