By James Bullen, ABC, 29 Jun 2016
Doctors have called for the public to discuss end of life care with their loved ones after a study revealed one third of elderly patients with advanced or terminal illnesses receive unnecessary treatment in the last six months of their lives.
The global analysis of 38 studies of end of life care, published in the International Journal for Quality in Healthcare, found a significant number of patients received treatments that were of no benefit to them.
These included chemotherapy, radiotherapy and CPR, when a person had a not-for-resuscitation order.
Lead author Dr Magnolia Cardona-Morrell, a senior research fellow at the University of New South Wales, found some non-beneficial treatments prevented patients from having a comfortable death.
“Some of these treatments are geared towards making the patient more comfortable, but the idea is that some of them are too aggressive to be of benefit to the patient,” she said.
“For example, applying CPR on an elderly [person] who has a not-for-resuscitation order, or admitting them to intensive care for over a week, or starting chemotherapy, or dialysis in the last days of life.”
Non-beneficial treatment was defined in the research as medicine, procedures, or tests administered when a patient was naturally dying, but which did not improve their chances of survival or their quality of life. The analysis found one in three elderly patients with an advanced or irreversible condition were treated with chemotherapy in their last six weeks of life, while one in four of those with not-for-resuscitation orders received CPR.
The results were broadly similar across the countries analysed, which included the United States, the UK, and Australia.
The analysis also considered why patients were receiving non-beneficial treatments.
It found families pressured doctors to do everything possible for a patient, and the tension for doctors between saving lives and letting a patient die with dignity, were contributing factors.
Dr Magnolia Cardona-Morrell said a lack of dialogue between doctors and families prior to a person progressing to an advanced stage of illness also contributed to negative outcomes.
“If that conversation hasn’t been held, or there is no advanced care directive, the doctor and the patient’s family are in a dilemma about what do they fight,” she said.
“And in some cases this results in these non-beneficial treatments.”
Dr Magnolia Cardona-Morrell said people should talk about their end of life care options before they became terminally ill, saying it was one way to limit further unnecessary treatment in the healthcare system.
“I would propose that the public start the conversation with their relatives and their GP as soon as possible.”
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