Study Says Doctors Often Opt Out of End-of-Life Care

A new study from the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital (BWH) found that doctors receive significantly less end-of-life care than the general public.

“Our analysis confirms what we’ve long speculated, which is that physicians, who are more likely to have first-hand experience with the burdens and futility of end-of-life care, are less likely to have surgery or be admitted to the ICU during the last six months of life, or to die in the hospital,” Joel Weissman, deputy director and chief scientific officer at CSPH, said in a statement.

Researchers analyzed the Medicare data of nearly 2,400 deceased physicians and rated their end-of-life care intensity based on surgery, hospice care, admission into the intensive care unit (ICU), money spent, and whether they died in the hospital. They then compared that data with lawyers’ end-of-life care, to see how people of a comparable education level and socioeconomic standing dealt with treatment. They further analyzed those groups against the general population, looking at data for 666,500 people, and found that doctors take comparably mild end-of-life actions.

That the physicians who work to extend the lives of others—and thus have the most intimate knowledge of end-of-life care—are opting out of such procedures suggests that life-extension efforts may do more harm than good.

“This research could have a significant impact on clinical practice, especially in the way that health care professionals communicate with patients and family members about end-of-life care options,” said Zara Cooper, a BWH trauma surgeon, in the statement.

Many patients ask their doctors for advice about end-of-life care, and, as of January 1, Medicare now pays doctors for their time during these counseling sessions, so the study results may lead to more productive conversations about end-of-life options.

“The findings provide a form of doctor testimonial recommending less aggressive end-of-life care and highlight the need for economic and human resources to support home deaths,” said senior author Holly Prigerson.