The necessary improvements in care at the end-of-life for patients with organ failure ;
Historically, efforts to improve care at the end of his life they have focused mainly on cancer patients. However, few studies have examined the quality of care at the end of its useful for patients with other serious illnesses, such as lung, kidney or heart failure or dementia life. In a study of patients who died at 146 hospital centers within the health system of Veterans Affairs, a research team led by researchers from Brigham and Women’s Hospital has he found that care informed family at the end of his life was significantly better in patients with cancer or dementia than for patients with other serious illnesses. The team’s findings were presented today at the Annual Meeting of AcademyHealth Research and published simultaneously in JAMA Internal Medicine .
“We need to expand our attention to improving the quality of attention at the end of its life for all patients , not just those with cancer or dementia “said lead author Melissa Wachterman, MD, MPH, MSc, assistant professor of medicine at the School of medicine at Harvard and a doctor both in the Department of psychosocial Oncology and palliative care at Dana-Farber / Brigham and Center Women and Health System Boston VA cancer. “Our study shows that while there is room for improvement in the quality of care at the end of its useful life in all patients, this is particularly true for patients dying from heart failure chronic lung disease and renal failure. ”
The study examined the medical records of family and surveys more than 34,000 patients who died in the VA health system between 2009 and 2012. The researchers found that patients with end-stage renal disease, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease) and fragility were much less likely to receive palliative care consultations for patients with cancer or dementia. Approximately one third of these patients died in intensive care unit , more than double the rates for people with cancer or dementia, and were less likely to have orders not to DNR.
Overall, the research team found that patients who had been seen by a palliative care physician – a doctor who specializes in the management of symptoms and support around making medical decisions for patients severely the patients reported better care at the end of its useful life, according to their families.
“Increasing access to palliative care at the end of life may improve the quality of care at the end of its useful for those with heart, lung life, and kidney disease – a group which is growing rapidly with the increasing number of older Americans who die from these diseases, “said Wachterman.
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