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Study: Doctor-patient conversations at end of life associated with lower medical expenses
Date:3/9/2009

BOSTON--Few physicians are eager to discuss end-of-life care with their patients. Yet such conversations may result in better quality of life for patients and could lower national healthcare expenditures for cancer care alone by tens of millions dollars each year, according to a study led by researchers at Dana-Farber Cancer Institute.

As reported in the March 9 issue of the Archives of Internal Medicine, investigators interviewed 603 advanced cancer patients about whether they had an end-of-life (EOL) conversation with their physician. The researchers calculated the final week health-care costs of patients who reported such conversations and compared them to those of patients who did not.

They found that patients who reported having an EOL conversation had an estimated average of $1,876 in health-care expenses during their final week of life, compared to $2,917 for those who didn't, a difference of $1,041, or 36 percent. Higher costs -- typically the result of more intensive, life-prolonging care -- were also associated with a worse quality of death during patients' final week. In addition, patients typically did not live longer if they received intensive care.

"We refer to the end-of-life discussion as the multi-million dollar conversation because it is associated with shifting costs away from expensive, burdensome, non-curative care, like being on a ventilator in an ICU, to less costly comfort care provided at home or in hospice, which most patients and their families say they would prefer," says the study's senior author, Holly Prigerson, PhD, of Dana-Farber. "As the nation looks to ways to improve patient care and reduce costs of healthcare, end-of-life conversations should be considered. Policies that promote increased communication, such as incentives for end-of-life conversations, may be cost-effective ways to both improve care and reduce some of the rising health care expenditures."

Previous studies have sho
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Contact: Bill Schaller
william_schaller@dfci.harvard.edu
617-632-5357
Dana-Farber Cancer Institute
Source:Eurekalert

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