Study: Doctor-patient conversations at end of life associated with lower medical expenses

Mar 09, 2009

Few physicians are eager to discuss end-of-life care with their patients. Yet such conversations may result in better quality of life for patients and could lower national healthcare expenditures for cancer care alone by tens of millions dollars each year, according to a study led by researchers at Dana-Farber Cancer Institute.

As reported in the March 9 issue of the , investigators interviewed 603 advanced cancer about whether they had an end-of-life (EOL) conversation with their physician. The researchers calculated the final week health-care of patients who reported such conversations and compared them to those of patients who did not.

They found that patients who reported having an EOL conversation had an estimated average of $1,876 in health-care expenses during their final week of , compared to $2,917 for those who didn't, a difference of $1,041, or 36 percent. Higher costs -- typically the result of more intensive, life-prolonging care -- were also associated with a worse quality of death during patients' final week. In addition, patients typically did not live longer if they received intensive care.

"We refer to the end-of-life discussion as the multi-million dollar conversation because it is associated with shifting costs away from expensive, burdensome, non-curative care, like being on a ventilator in an ICU, to less costly comfort care provided at home or in hospice, which most patients and their families say they would prefer," says the study's senior author, Holly Prigerson, PhD, of Dana-Farber. "As the nation looks to ways to improve patient care and reduce costs of healthcare, end-of-life conversations should be considered. Policies that promote increased communication, such as incentives for end-of-life conversations, may be cost-effective ways to both improve care and reduce some of the rising health care expenditures."

Previous studies have shown that a disproportionate share of health-care spending in the United States is incurred at the end of life and that patients who speak with their physicians about end-of-life preferences have fewer life-sustaining procedures and lower rates of intensive care admission. The study by Prigerson and her colleagues suggests a direct link between communications at the end of life with lower health care costs and better quality of life for patients with advanced cancers.

The paper is part of a multi-institutional study called Coping With Cancer. Funded by the National Institute of Mental Health and the National Cancer Institute, the study tracks the health and psychological state of 627 patients nationwide with advanced cancer.

Although the study doesn't purport to show a cause-and-effect relationship between EOL conversations and lower medical costs, it does suggest a strategy for reducing such costs and for improving patients' quality of life as death approaches, notes Prigerson, who is also on faculty at Brigham and Women's Hospital and Harvard Medical School. If the national proportion of patients reporting EOL discussions was increased to 50 percent, the annual cost savings could be more than $76 million dollars, researchers estimate, based on the annual number of cancers deaths in the U.S.

Source: Dana-Farber Cancer Institute

Explore further: Changing cows' diet could help tackle heart disease

add to favorites email to friend print save as pdf

Related Stories

Heart attack not a death sentence

Jul 18, 2008

Survivors of cardiac arrest who received intensive care can expect long-term quality of life at reasonable expense to the health care system. Research published today in BioMed Central's open access journal Critical Care is the ...

Recommended for you

US judge overturns state's abortion law (Update)

17 hours ago

A federal judge on Wednesday overturned a North Dakota law banning abortions when a fetal heartbeat can be detected, as early as six weeks into pregnancy and before many women know they're pregnant.

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

E_L_Earnhardt
not rated yet Mar 09, 2009
Wouldn't it be strange if doctors, and patients, were all allowed to talk freely as friends. The doctor might feel free to TRY something risky with the patient's permission, and it might WORK! A new
proceedure might be born!

More news stories

Firm targets 3D printing synthetic tissues, organs

(Medical Xpress)—A University of Oxford spin-out, OxSyBio, will develop 3D printing techniques to produce tissue-like synthetic materials for wound healing and drug delivery. In the longer term the company ...

Survival hope for melanoma patients thanks to new vaccine

(Medical Xpress)—University of Adelaide researchers have discovered that a new trial vaccine offers the most promising treatment to date for melanoma that has spread, with increased patient survival rates and improved ability ...

Naps help infants learn

Sleep is essential in helping young children apply what they learn, according to new research by Rebecca Gómez, associate professor in the UA Department of Psychology. In this Q&A, she talks about her new ...

Robotics goes micro-scale

(Phys.org) —The development of light-driven 'micro-robots' that can autonomously investigate and manipulate the nano-scale environment in a microscope comes a step closer, thanks to new research from the ...

Biologists help solve fungi mysteries

(Phys.org) —A new genetic analysis revealing the previously unknown biodiversity and distribution of thousands of fungi in North America might also reveal a previously underappreciated contributor to climate ...