Physicians do not Prefer Aggressive Treatments that they Offer to Terminally Ill Patients, Study


Most physicians do not prefer taking aggressive, life-prolonging treatments when terminally ill, but nevertheless prescribe it to patients facing the same prognosis, according to a Stanford University School of Medicine study.

"A big disparity exists between what Americans say they want at the end of life and the care they actually receive," the researchers said in a press release. "More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden."

For the study, the researchers compared physicians' attitudes toward advance directives since passage of the Self-Determination Act in 1990. Advance directives also revealed patients' end-of-life care preferences.

One group consisted of 1,081 physicians, who completed an online advanced directive form in 2013 and a 14-item advance directive attitude survey at the Stanford Hospital & Clinics and Veterans Affairs Palo Alto Health Care System, while the other group had 790 physicians from Arkansas, who were asked the same 14 survey questions in a 1989 study.

The researchers found that doctors' attitudes toward advance directives changed little in 25 years. The lack of change means continuation of aggressive treatments at the end of life despite most Americans preferring to die at home without life-prolonging interventions.

The researchers also found that nine out of 10 physicians from 2013 batch said that they would select a Do-Not-Resuscitate or "no code" status near the end of life.

"Patients' voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system," said VJ Periyakoil, MD, clinical associate professor of medicine and lead author of the study.

The finding is published in the journal PLoS One.

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