July 30, 2018 – End of Life Care and Geography

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Anchor lead: Places where physicians are not comfortable talking about end of life rendered their patients more likely to receive more expensive care before death, Elizabeth Tracey reports

What accounts for an almost two-fold difference in spending on end of life cancer care around the US? A recent Health Affairs study found it was all about the doctor. Rab Razzak, a palliative care expert at Johns Hopkins, explains.

Razzak: What this showed was that this is actually physician comfort level and understanding of these difficult discussions and lack of understanding of this care that directed some of these outcomes, and the cost issue. There were about close to 1200 patients looking at their cost of care. It turns out regionally, in areas where they had high costs with physicians in that region actually had less comfort in discussing end of life issues, DNR status, had less comfort addressing goals of care.   :30

Razzak says higher costs are simply a marker for additional care that may be inappropriate and that most patients say they don’t want, along with hospitalizations. He notes that when people are comfortable and their symptoms are managed, the vast majority indicate they’d rather be at home. At Johns Hopkins, I’m Elizabeth Tracey.