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Study details costs of providing care inconsistent with patient wishes

A new study led by Brown University researchers shows more than one-third of gravely ill patients who ask for palliative care get something else instead: life-extending treatments that often prolong their pain and suffering.

The study also finds that patients who receive more aggressive, life-prolonging care have longer survival times but incur medical costs nearly twice as high as the palliative care they originally requested.

"This is the first study to confirm anecdotal reports that many seriously ill persons who want their care to focus on comfort believe they are receiving care contrary to that preference," said Joan M. Teno, M.D., lead author of the study.

"The findings have implications for health care costs and length of survival," she said. "Costs are lower for those persons who report that their medical care is consistent with their preference to focus on their comfort. This provides the alluring possibility of an ethically defensible reduction in health care costs."

Teno and colleagues studied 1,185 seriously ill people about the 10th day of their hospitalization. They found that 60 percent expressed a preference for their care to focus on comfort but 35 percent of those patients believed they received aggressive treatment instead.

Persons who wanted comfort care and who believed they got it had one-year health costs of $52,098 and a one-year survival rate of 38 percent. This compared to $92,442 for patients who said their life-extending treatment was not in accord with their preferences for palliation. This latter group had a one-year survival rate of 55 percent.

Even after adjusting the findings for disease severity, age and other factors, the researchers found that patients who wanted but did not receive comfort care had medical costs 1.4 times higher than patients who did.

The study appears in the March issue of the Journal of the American Geriatric Society. Teno is associate director of the
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Contact: Scott Turner
Scott_Turner@Brown.edu
401-863-1862
Brown University
4-Mar-2002


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