Caregivers may be focusing on 'futile' measures: Brown study

New research concludes that nursing home caregivers well-versed in palliative care tend to focus less on possibly futile “aggressive” life-saving measures.

Meanwhile, a national advocacy group for the terminally ill has released a report concluding that well-intentioned efforts may be ignoring patients' true wishes by rejecting life-preserving treatment.

In a study published in a recent issue of the Journal of Palliative Medicine, Brown University researchers assert that caregivers ignorant of palliative care methods tend to exacerbate a dying nursing home patient's distress when taking aggressive measures such as feeding tubes. Those caregivers who understand palliative care, meanwhile, tend to take far fewer aggressive life-saving steps.

The Brown study surveyed more than 1,900 nursing home directors between July 2009 and June 2010 to assess their knowledge, and their facility's use of palliative care. Close to half (43%) of those surveyed said they were well-versed; about 20% reported having virtually no experience with or knowledge of palliative care.

"While the Institute of Medicine has called for greater access to skilled palliative care across settings, the fact that one in five U.S. nursing home directors of nursing had very limited palliative care knowledge demonstrates the magnitude of the challenge in many nursing homes," said Susan C. Miller, professor of health services, policy and practice in the Brown University School of Public Health and lead author of the study.

Meanwhile, the National Right to Life Committee issued a lengthy report in March, “The bias against life-preserving treatment in advance care planning,” which raises concerns that some overzealous caregivers may be skipping life-preserving treatment because they are “motivated by cost concerns, promotion of advance directives and advance care planning.”