Sunday, September 19, 2010

aggressive, hospital-based end-of-life care

Dana-Farber Cancer Institute (September 13, 2010)

Death at Home Less Distressing for Cancer Patients and Families

Study finds caregivers at higher risk for mental illness when patients with advanced cancer die in hospital/ICU

Cancer patients who die in the hospital or an intensive care unit have worse quality of life at the end-of-life, compared to patients who die at home with hospice services, and their caregivers are at higher risk for developing psychiatric illnesses during bereavement, according to a study by researchers at Dana-Farber Cancer Institute.

One striking finding of the study, reported in the September 13th issue of the Journal of Clinical Oncology, was that bereaved caregivers of patients who died in an intensive care unit (ICU) were five times more likely to be diagnosed with Posttraumatic Stress Disorder (PTSD), compared with caregivers of patients who died at home with hospice services.

"This is the first study to show that caregivers of patients who die in ICUs are at a heightened risk for developing PTSD," wrote the authors, led by Alexi Wright, MD, a medical oncologist and outcomes researcher at Dana-Farber.

In addition, families and loved ones of patients who died in the hospital, though not in an ICU, were at higher risk of developing Prolonged Grief Disorder (PGD), an intense and disabling form of grief which lasts more than 6 months.

The report comes at a time of growing concern over the appropriateness of aggressive, hospital-based end-of-life care for terminal cancer patients.

The authors noted that although most cancer patients would prefer to spend their last days at home, 36 percent die in a hospital and 8 percent in an ICU and may be subjected to invasive and painful procedures at the end of life.

In contrast to home or hospice care that emphasizes alleviating pain and discomfort and providing a peaceful death, ICU care can be traumatic for patients and their family and caregivers, said Wright.

The report, whose senior author is Holly Prigerson, PhD, director of Dana-Farber's Center for Psycho-oncology & Palliative Care Research, contains findings from a prospective, longitudinal study of advanced cancer patients recruited at seven cancer centers from 2002 to 2008.

These findings are important for both patients and physicians, said Wright.

"If patients are aware that more-aggressive care may affect not only their quality of life, but also their loved ones after their death, they may make different choices."

The research was supported by grants from the National Institute of Mental Health and the National Cancer Institute.

Reference:

Place of Death: Correlations With Quality of Life of Patients With Cancer and Predictors of Bereaved Caregivers' Mental Health.
Alexi A. Wright, Nancy L. Keating, Tracy A. Balboni, Ursula A. Matulonis, Susan D. Block and Holly G. Prigerson
Journal of Clinical Oncology, 2010; DOI: 10.1200/JCO.2009.26.3863

Link to JCO abstract

Link to Dana Farber news release [with link to video]

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