How Often Is End-of-Life Care in the United States Inconsistent with Patients' Goals of Care?

Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes. To document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors o...

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Vydáno v:	Journal of palliative medicine Ročník 20; číslo 12; s. 1400
Hlavní autoři:	Khandelwal, Nita, Curtis, J Randall, Freedman, Vicki A, Kasper, Judith D, Gozalo, Pedro, Engelberg, Ruth A, Teno, Joan M
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.12.2017
Témata:	Aged Aged, 80 and over Family - psychology Female Humans Male Patient Care Planning - organization & administration Patient Care Planning - statistics & numerical data Patient Preference - psychology Quality of Health Care - organization & administration Quality of Health Care - statistics & numerical data Retrospective Studies Terminal Care - organization & administration Terminal Care - psychology United States goals of care communication palliative care end-of-life care
ISSN:	1557-7740, 1557-7740
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Abstract	Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes. To document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care. Retrospective analysis of nationally representative survey data of persons aged >65 years. Settings/Subjects: Bereaved family members responding to the last month of life component of the National Health and Aging Trends Study. Methods/Measurements: Bereaved family members assessed treatment decisions and their consistency with patients' wishes, unmet needs, and quality of care. We examined differences between patients receiving inconsistent versus consistent care. A total of 1212 family members were interviewed, representing (when weighted) 4.8 million decedents. Thirteen percent stated that care was inconsistent with decedent's wishes. Consistent care was unassociated with patient's sex, age, or race/ethnicity. Death at home was more likely to represent consistent care, and death in the hospital or nursing home was more likely to represent inconsistent care (p = 0.052). Respondents reporting inconsistent care were more likely to rate the quality of care as fair or poor (19.1% vs. 4.8%, p < 0.001), reported more unmet needs for pain management (30.5% vs. 19.4%, p = 0.037), and reported more concerns with communication (29.8% vs. 17.0%, p = 0.003). One in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians.
AbstractList	Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes.BACKGROUNDDespite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes.To document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care.OBJECTIVETo document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care.Retrospective analysis of nationally representative survey data of persons aged >65 years. Settings/Subjects: Bereaved family members responding to the last month of life component of the National Health and Aging Trends Study. Methods/Measurements: Bereaved family members assessed treatment decisions and their consistency with patients' wishes, unmet needs, and quality of care. We examined differences between patients receiving inconsistent versus consistent care.DESIGNRetrospective analysis of nationally representative survey data of persons aged >65 years. Settings/Subjects: Bereaved family members responding to the last month of life component of the National Health and Aging Trends Study. Methods/Measurements: Bereaved family members assessed treatment decisions and their consistency with patients' wishes, unmet needs, and quality of care. We examined differences between patients receiving inconsistent versus consistent care.A total of 1212 family members were interviewed, representing (when weighted) 4.8 million decedents. Thirteen percent stated that care was inconsistent with decedent's wishes. Consistent care was unassociated with patient's sex, age, or race/ethnicity. Death at home was more likely to represent consistent care, and death in the hospital or nursing home was more likely to represent inconsistent care (p = 0.052). Respondents reporting inconsistent care were more likely to rate the quality of care as fair or poor (19.1% vs. 4.8%, p < 0.001), reported more unmet needs for pain management (30.5% vs. 19.4%, p = 0.037), and reported more concerns with communication (29.8% vs. 17.0%, p = 0.003).RESULTSA total of 1212 family members were interviewed, representing (when weighted) 4.8 million decedents. Thirteen percent stated that care was inconsistent with decedent's wishes. Consistent care was unassociated with patient's sex, age, or race/ethnicity. Death at home was more likely to represent consistent care, and death in the hospital or nursing home was more likely to represent inconsistent care (p = 0.052). Respondents reporting inconsistent care were more likely to rate the quality of care as fair or poor (19.1% vs. 4.8%, p < 0.001), reported more unmet needs for pain management (30.5% vs. 19.4%, p = 0.037), and reported more concerns with communication (29.8% vs. 17.0%, p = 0.003).One in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians.CONCLUSIONSOne in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians. Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes. To document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care. Retrospective analysis of nationally representative survey data of persons aged >65 years. Settings/Subjects: Bereaved family members responding to the last month of life component of the National Health and Aging Trends Study. Methods/Measurements: Bereaved family members assessed treatment decisions and their consistency with patients' wishes, unmet needs, and quality of care. We examined differences between patients receiving inconsistent versus consistent care. A total of 1212 family members were interviewed, representing (when weighted) 4.8 million decedents. Thirteen percent stated that care was inconsistent with decedent's wishes. Consistent care was unassociated with patient's sex, age, or race/ethnicity. Death at home was more likely to represent consistent care, and death in the hospital or nursing home was more likely to represent inconsistent care (p = 0.052). Respondents reporting inconsistent care were more likely to rate the quality of care as fair or poor (19.1% vs. 4.8%, p < 0.001), reported more unmet needs for pain management (30.5% vs. 19.4%, p = 0.037), and reported more concerns with communication (29.8% vs. 17.0%, p = 0.003). One in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians.
Author	Engelberg, Ruth A Gozalo, Pedro Freedman, Vicki A Khandelwal, Nita Kasper, Judith D Teno, Joan M Curtis, J Randall
Author_xml	– sequence: 1 givenname: Nita surname: Khandelwal fullname: Khandelwal, Nita organization: 1 Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington , Seattle, Washington – sequence: 2 givenname: J Randall surname: Curtis fullname: Curtis, J Randall organization: 3 Department of Medicine, University of Washington , Seattle, Washington – sequence: 3 givenname: Vicki A surname: Freedman fullname: Freedman, Vicki A organization: 4 Institute for Social Research, University of Michigan , Ann Arbor, Michigan – sequence: 4 givenname: Judith D surname: Kasper fullname: Kasper, Judith D organization: 5 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland – sequence: 5 givenname: Pedro surname: Gozalo fullname: Gozalo, Pedro organization: 6 Department of Health Services, Policy, and Practice, Brown University School of Public Health , Providence, Rhode Island – sequence: 6 givenname: Ruth A surname: Engelberg fullname: Engelberg, Ruth A organization: 3 Department of Medicine, University of Washington , Seattle, Washington – sequence: 7 givenname: Joan M surname: Teno fullname: Teno, Joan M organization: 7 Division of Gerontology and Geriatric Medicine, Harborview Medical Center , Seattle, Washington
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Snippet	Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes. To... Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients'...
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SubjectTerms	Aged Aged, 80 and over Family - psychology Female Humans Male Patient Care Planning - organization & administration Patient Care Planning - statistics & numerical data Patient Preference - psychology Quality of Health Care - organization & administration Quality of Health Care - statistics & numerical data Retrospective Studies Terminal Care - organization & administration Terminal Care - psychology United States
Title	How Often Is End-of-Life Care in the United States Inconsistent with Patients' Goals of Care?
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