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 The question of what kind of care doctors themselves would receive
is often on patients' and families' minds, the researchers say.
"Family members of critically or terminally ill patients sometimes
seek reassurance from the physician that their loved ones are
receiving the same care their physicians would receive," said lead
author Joel Weissman, of Brigham and Women’s Hospital in Boston.
Previous research teams have asked doctors what treatments or
services they would choose at the end of their lives, but what care
they actually received hasn't been clear, Weissman told Reuters
Health.
As reported in JAMA, the researchers compared 2,396 doctors and
665,579 members of the general population, all at least 66 years
old, who died in 2004 or 2005 in four U.S. states.
They analyzed services received in the last six months of life,
including surgery, hospice care, intensive care, and whether the
person died in a hospital.
Overall, the doctors received less aggressive care. About 28 percent
of them died in a hospital, compared to 32 percent of the general
population. About 25 percent of doctors had surgery in the last six
months of life, compared to about 27 percent of the general public.
And about 26 percent of doctors were admitted to intensive care
units in the last months of life, versus about 28 percent of the
general population.
Doctors were more likely, however, to receive hospice care and to
use less costly care before death, but those findings may be due to
chance.
"Doctors understand (that) modern medicine can both help and harm
people, especially at the end of life, and they understand its
limits," said Weissman.
The researchers also compared the doctors to 2,081 similarly aged
lawyers who died around the same time, since lawyers and physicians
tend to have similar educations and similar social and economic
statuses. Other than lawyers being more likely to die in hospitals,
the two groups received similar levels of care at the end of life.
"What this says is that there is something about occupation and
socioeconomic status that influences end-of-life care, but doctors
still tend to receive less intensive end-of-life care," said
Weissman.
The similarities between end of life care for the two professions
may also be due to the fact that lawyers have helped clients with
end-of-life planning, like estate planning and do-not-resuscitate
orders, Dr. VJ Periyakoil of Stanford School of Medicine in
California told Reuters Health.
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"We’ve seen what goes terribly wrong when people are not prepared or
not sure what people want for themselves," Periyakoil said about
doctors. "Whereas with lawyers, the angle would be slightly
different."
The new study didn't analyze how satisfied people were with the care
they received at the end of their lives, but Weissman said the
consensus is that a good death is consistent with a person's goals
and preferences.
"I think the big message is to have a conversation with your
physician no matter what your age," he said. "And think of this
study when thinking about your goals."
Periyakoil, who was not involved with the new study, said her own
research shows that about 99 percent of doctors report barriers in
discussing end-of-life care with their patients.
"A conversation with your doctor is really important, but I think
it’s equally important that you don’t wait for your doctor" to
initiate it, she said.
She has led the creation of the Letter Project, which guides people
through writing down their wishes for their doctors (http://med.stanford.edu/letter.html).
"We’re hoping once a patient documents it, doctors will take the
opportunity to have a very focused discussion," said Periyakoil.
She said people can also talk with their families about their goals
and preferences.
SOURCE: http://bit.ly/1Pf2bwb JAMA, online January 19, 2016.
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