End-of-life care communication, patient assessments need improvement, researchers say

Between 10% and 12% of the entire U.S. healthcare budget is spent treating patients during their last year of life. Despite the amount, a number of improvements could be made to end-of-life care, according to a new report.

A research team at the University of California, Los Angeles, analyzed the medical records of 496 older adults who spent at least three days in a university medical center before they died. Their care was evaluated using 13 different quality indicators, including pain management, breathing difficulty and overall stress or agitation. Researchers found that those three indicators were the most prevalent in patients before death, and that many patients dying in the hospital receive burdensome care.

While patients typically received appropriate care for 70% of the quality indicators, follow-up care for distressing symptoms, such as breathing difficulty, was much less rigorous, according to the report. In cases where patients' breathing tubes were removed before death, only 29% were evaluated for breathing difficulty. Better communication with patients about treatment options, as well as breathing assessments and other end-of-life considerations should be targeted for quality improvement, according to researchers. The report appeared in the June 28 issue of the Archives of Internal Medicine.