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VA RESEARCH QUARTERLY UPDATE
This Issue: The Aging Veteran | Table of Contents: Summer 2016 |

In the News

End-of-life wishes and satisfaction with care



A VA study compared end-of-life care for patients with different medical conditions. <em>(Photo for illustrative purposes only. ©iStock/Lighthaunter)</em>
A VA study compared end-of-life care for patients with different medical conditions. (Photo for illustrative purposes only. ©iStock/Lighthaunter)

A VA study compared end-of-life care for patients with different medical conditions. (Photo for illustrative purposes only. ©iStock/Lighthaunter)

Physicians tend to be more likely to accommodate the advanced-care wishes for end of life care of patients with cancer or dementia than those with renal disease, congestive heart failure, pulmonary disease, or frailty.

This was the major finding of a study published online June 26, 2016, in JAMA Internal Medicine. The study was led by Dr. Melissa W. Wachterman of the VA Boston Health Care System, the Brigham and Women's Hospital in Boston, and the Dana Farber Cancer Institute.

MedCity News reported on the study June 28. The article featured an interview with Wachterman on her team's findings.

"There's been a lot of focus on end-of-life care for cancer," she said. "But most people don't die of cancer. And the quality of end-of-life care for those dying of other conditions is not as good."

The research team looked at survey data from the families of about 34,000 people who had died at VA health care facilities between Oct. 1, 2009, and Sept. 30, 2012. About 60 percent of those whose relatives died of cancer or dementia reported that their relative got "excellent" end-of-life treatment. Fewer than 55 percent of the families of those who died of end-stage renal disease, cardiopulmonary failure, or frailty gave their relatives' care the same rating.

The study cited several reasons for this disparity. Veterans with cancer or dementia had higher rates of palliative care consultations, were more likely to have completed do-not-resuscitate orders, and died more often in hospice settings than in hospitals. Research shows these are issues that terminally ill patients and their families consider important.

Wachterman suggested that doctors and patients alike don't often think to talk about death preferences until it seems unavoidable. There may be a broader understanding, she suggested, that cancer and dementia are terminal diseases, so there is a clearer timeline for when to start planning for death.

Though her study focused on VA, she told MedCity News she expected the same trends would bear out in other health care settings.


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