Among patients with advanced chronic kidney disease, receiving end-of-life care focused on life extension rather than comfort was linked with lower family satisfaction with care, according to new research led by the U.S. Department of Veterans Affairs (VA) and the University of Washington.
Patients who received intensive patterns of end-of-life care, which required more time in the hospital and included exhaustive procedures such as cardiopulmonary resuscitation (CPR) and mechanical ventilation, were associated with up to 5 percent lower overall family ratings of care. Family members of patients who received hospice services, a model of care focusing on relief from the symptoms and stress of illness, had 13 percent more favorable ratings.
The findings, published Aug. 29 in the Clinical Journal of American Society of Nephrology, raise concern that the very intensive patterns of care received by patients near the end of life may reflect low quality care, according to lead author Dr. Claire Richards, a post-doctoral research fellow at the VA Puget Sound Health Care System and the University of Washington School of Public Health’s Department of Health Services.
“Prior studies have shown that most prefer a comfort-oriented approach to end-of-life care,” Dr. Richards said. “We might be able to promote higher quality end-of-life care for this population, such as by strengthening nephrologists’ comfort with prognostic communication and offering more opportunities to patients and their families to discuss their values and goals of care.”Friday Letter Submission, Publish on September 06