Too Old and Too Sick for Treatment?
My visceral reaction to the latest report from the Dartmouth Atlas Project, which avers that aggressive care for dying patients is often futile- is nausea.
Their findings: Even though a large percentage of Medicare cancer patients represent poor prognoses, health care facilities are still offering overly aggressive and expensive inpatient procedures in the last month of life- without conclusive evidence that there will be positive results. These aforesaid procedures include: chemotherapy, intensive care, intubation, and feeding tubes.
“This is a time period where the use of chemotherapy is generally considered to be futile. Yet in some regions and medical centers, the rate in which chemotherapy was administered to patients with only weeks to live was as high as 10%,” David Goodman, MD, lead author and co-principal investigator of the report, said at a news conference Tuesday.
Goodman, who also is the director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice , attributes obstacles to the appropriate usage of palliative care and hospice services for patients who are clearly dying , to be the “unfavorable payment (to hospitals and doctors) compared to the alternative, which we’re calling curative care, including chemotherapy, which is more richly reimbursed, as the reason to more appropriate use”
Goodman described “a sort of a cultural norm in oncology, and of physicians in general, to press on with efforts to extend life, even when that’s not possible.”
“Doctors and health systems need to take a look at themselves,” he said. “They need to examine where they need to make their investments, and to make sure that they’re fairly investing in what I think is one of the most undertreated (services) that we have in Medicare today, and that is under treatment with palliative care and hospices services for those with advanced disease.”
And, he said, they need to be more honest with their patients, and provide realistic expectations about their chances for cure at this late stage of their disease.
Anybody remember what Sarah Palin said about Death Panels?