JAMA Publishes New Study on End-of-Life Care, Identifies Disparities & Worsening Trends
We took special note of this study in JAMA Internal Medicine because it is so relevant to the need for improved care quality at the end-of life, and the role of community-based palliative care for these individuals who are facing the specialized challenges of advanced illness.
According to the survey results, respondents encountered deficiencies in quality for both black and white patients who died, although they found no significant racial differences in various aspects of the quality of end-of-life care. Participants cited unmet symptom needs, problems with communication and less than optimal decision-making.
Researchers noted that the results add to previously reported concerns that the quality of end-of-life care may be worsening for older people in general. They suggest that improvements are needed for all patients in the United States.
End-of-Life Care Survey Overview
The research letter by Rashmi K. Sharma, M.D., M.H.S., University of Washington, Seattle, and co-authors analyzed survey data collected from 2011 to 2015 for the National Health and Aging Trends Study, which provides information on late life functioning using a national group of Medicare enrollees 65 or older.
Of the 1,726 interviews, 1,106 were completed by a family member or close friend of a white (n=825) or black (n=281) patient who died.
According to the results:
- Black patients were more likely than white patients to die in the hospital, specifically in the intensive care unit.
- Fewer black patients than white patients used hospice services in the last month of life.
- Survey respondents for white patients who died were more likely to report the person was not always treated with respect.
- About 1 of 5 survey respondents for both black and white patients who died reported that family members were not always kept informed.
While overall ratings of quality of care did not differ significantly, fewer than half of the survey respondents for both black and white patients who died reported the patient had received excellent end-of-life care.
Collaborative Opportunities to Improve Care Quality
These findings underscore the importance of initiatives to improve access to palliative care, such as the model from Turn-Key Health and others. Our PIM™ program is designed to answer many of the survey conclusions, and helps to improve quality of life for individuals nearing end-of-life.
Our model is now being implemented throughout the country. Individuals and family caregivers who are dealing with serious illnesses will be the beneficiaries of this unique level of care.