Experts criticize prevalence of costly operations in final year of life, tout decision-aids to reduce them

Share this content:

Decision aids being developed by many hospitals and health systems may help seniors choose not to have costly, invasive procedures that have been common in their final years.

Easy-to-understand materials can help patients make more informed medical decisions and set realistic expectations even in the midst of a crisis, experts told Kaiser Health News.

Nearly 1 in 3 Medicare patients undergo an operation in the year before they die, despite evidence showing many are more likely to be harmed than to benefit from it.

The rush of medical decisions “doesn't allow time to deliberate or consider the patients' overall health or what their goals and values might be,” said Jacqueline Kruser, M.D., an instructor in pulmonary and critical care medicine and medical social sciences at the Northwestern University Feinberg School of Medicine.

That kind of haste leads to surgeries that don't necessarily improve quality of life or extend it by much.

Cardiologist Rita Redberg, M.D., said the practice of so many late-in-life surgeries is financially driven and reinforced by a culture in which patients and doctors are reluctant to talk the realistic outcomes of surgical intervention.

“We have a culture that believes in very aggressive care,” she told Kaiser. “We are often not considering the chance of benefit and chance of harm, and how that changes when you get older. We also fail to have conversations about what patients value most.”

The expense of the surgeries themselves doesn't show true cost. It disregards the likelihood of hospital readmissions among the frail and elderly, stays in intensive care or moves to skilled nursing care if patients fail to regain independence.

Still, 18% of Medicare patients have surgery in their last month alive and 8% in their final week, according to a 2011 study in The Lancet.

After Kaiser Permanente Washington introduced decision tools relating to joint replacement, the number of patients opting for hip replacements fell 26%, while knee replacements declined 38%, according to a study in Health Affairs.