News & Commentary

Quality of end-of-life care depends on condition


End-of-life care is just like other kinds of health care. Some of it is good, some bad, and there’s the in-between. And new research suggests that people who die with a cancer or dementia diagnosis are more likely to get the good care than those with other conditions.

Researchers at Brigham and Women’s Hospital in Boston looked at data collected from the families of about 34,000 people who died in Veterans Affairs hospitals between Oct. 1, 2009, and Sept. 30, 2012. Measures of quality end-of-life care include giving patients and families information on palliative care in the last 90 days of life, having a do-not-resuscitate order at the time of death, and dying in a hospice or palliative care unit.

By diagnosis, percent who died in the ICU

Source: Wachterman MW et al., JAMA Internal Medicine, June 26, 2016

Only half the patients with end-stage renal disease and less than half with cardiopulmonary failure or frailty received consultations about palliative care in the last 90 days of life, according the study, which was published recently in JAMA Internal Medicine. In contrast, 73.5% of patients with cancer and 61.4% of patients with dementia received such consultations.

Deaths in the intensive care unit (ICU) were also telling: 13.4% of cancer patients and 8.9% with dementia died in the ICU, compared with 32.3% of those with end-stage renal disease and 34.1% with cardiopulmonary failure.

The authors concede that their findings might not be generalizable to patients outside the VA system, but note that research comparing end-of-life care in and outside of the VA suggests that care is pretty similar.