Tuesday, November 16, 2010

Dartmouth Atlas Report Identifies Gap between Patient Wishes and Care Received

NHPCO Commends Dartmouth Atlas Project and Calls on Hospitals to Increase Access to Hospice Care

(Alexandria, Va) – A new report released today from the Dartmouth Atlas Project showing that individuals in some areas of the country are far less likely to receive comfort care in accordance with their wishes and has drawn the attention of the nation’s hospice and palliative care community.

This first-ever report from the Dartmouth Atlas Project on cancer care at the end of life, found that across the US, about 29 percent of patients with advanced cancer died in a hospital between 2003 and 2007. And in 50 academic medical centers, fewer than half of these patients received hospice care.

Furthermore, the study authors state that many patients are aggressively treated with curative therapies they may not want, and, “for frail elderly patients, and any patient with advanced cancer, these treatments have limited or no benefit.”

“The Dartmouth Atlas Project is to be commended for undertaking this thorough examination of end-of-life care for Medicare beneficiaries with advance cancer,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “While the findings of variation in care are not necessarily a surprise, one of the key messages that I take away from this report is the critical need for hospitals and all healthcare professionals to ensure that all patients are informed earlier about the course of an illness and the range of options available – options that include hospice and palliative care.”

The likelihood that a Medicare patient with advanced cancer will die with the support of hospice care, or in the hospital without hospice, varies markedly depending on where he or she lives and receives care. The percent of cancer patients dying in a hospital varied threefold among patients receiving most of their care at academic medical centers.

“It’s important to recognize that this report is not a negative comment on care in our nation’s hospitals or among academic medical centers, rather, it’s a much needed reminder that healthcare professionals must work to help patients and families understand where the course of their illness may take them. And, when cure is not possible, it is our duty to offer the robust benefits that the hospice team can provide,” added Schumacher.

Hospice care provides coordinated care delivered by a team of interdisciplinary professionals that are trained to address the special needs a person has at the end of life. The hospice team provides pain and symptom relief as well as emotional and spiritual support for the patient and the family.

More than 1.56 million Americans received care from the nation’s hospices last year. However, 34 percent of patients died or were discharged in seven days or less – too short a time to take full advantage of all of the services available under hospice, including support for family caregivers.

“In more than 30 years of running hospice programs, the most frequent comment I would hear from patients and families was why they didn’t learn about hospice care earlier,” Schumacher noted.

For several years, NHPCO’s Caring Connections has been providing healthcare professionals and consumers with information about care options and caregiving when facing serious or life-limiting illness. Information to help patients and family caregivers understand the benefits of hospice care, speak with physicians about care, or learn about advance care planning is available free of charge from NHPCO’s Caring Connections at www.CaringInfo.org or by calling the HelpLine at 1-800-658-8898.


The Dartmouth Atlas Project is run by the Dartmouth Institute for Health Policy and Clinical Practice and principally funded by the Robert Wood Johnson Foundation. A link to the full study can be found at www.dartmouthatlas.org.

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO’s mission is to lead and mobilize social change for improved care at the end of life, www.nhpco.org.

Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139

1 comment:

Anonymous said...

I agree with this artical, and yes the issue of hospice care discussed in the hospital or doctors office is never addressed from my experiences working for a large hospital in phoenix and a large oncology practice in phoenix. The first example is the patient with failed liver transplant, in and out of the hospital for the past three years. Now in end stage liver disease again, with congestive heart failure, and hepatitis c. She was discharged from the hospital to a skilled nursing facility for physical therapy. She was then discharged from the skilled nursing facility to home health. I personally discussed comfort care in which this patient was in support of, the doctors never mentioned again.

In the oncology setting, the doctors usually give statistics and survival rates. I have seen patients treated until they have passed in pain and agony. Usually without their advanced directives taken care of. So they end up passing away in the icu or emergency room after being intubated and multiple life saving drugs pumped into them. The families are horrified and never forget the day their loved one passed on as it was a tramatic experience for them.

I am personally attempting to create a movement to provide patients with free hospice education and other services throught the foundation I am working with. To educate the public about end of life choices. The result so far has been negative. Oncologist don't want this service in their office. And hospitals have this service which is underutilized.

Hopefully I can get this program going as I personally wouldn't want to be agressivly treated when. I am terminally ill.