There's been a lot of emphasis in recent years on making sure that people with cancer get good end-of-life care, and that often involves consults with palliative care experts, referral to hospice and other strategies, but how do folks with other critical illnesses fare? That's the substance of a study Rick and I discuss on PodMed this week, as published in JAMA Internal Medicine, with the primary finding that those with frailty, COPD, congestive heart failure and end stage renal disease (ESRD) don't receive these services nearly as often as those with cancer or dementia. And there's room for improvement in cancer and dementia care also.
The records of almost 58,000 people who died while receiving care in Veterans Administration facilities between October 1, 2009, and September 30, 2012 were examined. About half of those patients with frailty, COPD, congestive heart failure, or ESRD had a palliative care consult while almost 74% of those with cancer did. Among those with dementia just over 61% did so.
What about deaths in the ICU? More than twice as many people without cancer or dementia died in this setting. Finally, loved ones of those who died rated their care as excellent at the end of life more often for those with cancer or dementia, a measure that the authors say was mediated by do-not-resuscitate orders, palliative care consults, and setting of death. Rick and I agree that there's lots of room for improvement here, with education for providers as well as patients important in shifting perception of palliative care from end-of-life issues to enabling people to live as best they can with symptom control.
Other topics this week are all in Annals of Internal Medicine: coprescription of opioids and naloxone, treatment of binge eating disorder, and the relationship of dementia to blood transfusions. Until next week, y'all live well.