Health Care Costs in the Last Week of Life: Associations with End of Life Conversations
By Baohui Zhang, A. Wright, H. Huskamp, M. Nilsson, M. Maciejewski, C. Earle, S. Block, P. Maciejewski, Holly Gwen Prigerson. Archives of Internal Medicine, 2009
914 citations recorded by the source corpus.
Background Life-sustaining medical care of cancer patients at the end-of-life (EOL) is costly. Patient-physician discussions about EOL wishes were found to be associated with lower rates of intensive interventions. Methods Coping with Cancer (CwC) is an NCI/NIMH-funded, longitudinal, multi-institutional study of 627 advanced cancer patients. Patients were interviewed at baseline and followed through death. Costs for ICU/hospital stays, hospice care and life-sustaining procedures (e.g., ventilation, resuscitation) received in the last week of life were aggregated. Generalized linear models were applied to test for cost differences in EOL care. Propensity score matching was used to reduce selection biases. Results 188 patients (31.2%) reported EOL discussions at baseline. After propensity score matching, the remaining 145 patients did not differ in socio-demographic characteristics, recruitment sites, illness acknowledgement or treatment preferences. Further analyses, adjusted by quintiles of propensity scores and significant confounders, revealed that the aggregate costs of care were $1876 (SE=177) for patients who reported EOL discussions compared with $2917 (SE=285) for patients who did not (in 2008 US dollars), a cost difference of $1041 (35.7% lower among patients who reported EOL discussions) [p=0.002]. Patients with higher costs had worse quality of death (Pearson partial r=-0.17, p=0.006) in their final week. Conclusions Advanced cancer patients who reported EOL conversations with physicians had significantly lower health care costs in their final week of life. Higher costs were associated with worse quality of death.
Subfields: Economics and Econometrics, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/08c07e36c7bcca337aa376920f4c34065f387e47
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Citations in the corpus
- Dying in America: improving quality and honoring individual preferences near the end of life. (2015, background): “Other studies of adults with serious illness suggest high-cost hospital-based treatment is often inconsistent with patient preferences and may contribute to patient suffering (Teno et al., 2002, 2007; Pritchard et al., 1998; Zhang et al., 2009; Yasaitis et al., 2009).”
- American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. (2009, background): “from the disease is strongly associated with higher end-of-life care costs.(182) However, delay or avoidance of a direct discussion of prognosis may be preferred by certain patients,(183) making empathic exchanges about prognosis difficult unless one specifically asks what the patient wants to know.”
- Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. (2010, background): “care expenditures are spent on intensive care in the final month of life,(9-11) despite limited evidence of improved patient outcomes.(12) A few studies have”