Most Americans die in the acute care hospital, where aggressive, life-prolonging interventions are readily performed.
Although patients with incurable illness might prefer palliative care, perceived differences in prognosis by physicians may influence the type of care provided.
Patients with advanced cancer and advanced dementia represent 2 extremes in the use of hospice services and may also be treated differently in the acute care hospital.
We tested this hypothesis and quantitated the use of nonpalliative interventions in hospitalized, incurably ill patients.
Charts of elderly patients with advanced dementia or metastatic solid tumor malignancy who died during a 13-month period in a tertiary care acute teaching hospital were reviewed.
Main outcome measures included the number of patients receiving invasive or noninvasive (but complex) diagnostic tests, invasive nonpalliative treatments, cardiopulmonary resuscitation, systemic antibiotics, and do-not-resuscitate orders.
Charts of 164 patients (80 with dementia and 84 with cancer) were reviewed.
Overall, 47% received invasive nonpalliative treatments.
Controlling for age, sex, length of stay, and insurance status, the groups were equally likely to receive nonpalliative treatments (P=75), but patients with dementia were more likely to receive new feeding tubes (P=02).
Cardiopulmonary resuscitation was attempted for 24% of each group. (...)
Mots-clés Pascal : Tumeur maligne, Métastase, Démence, Stade avancé, Stade terminal, Milieu hospitalier, Traitement, Diagnostic, Vieillard, Homme, Etats Unis, Amérique du Nord, Amérique, Traitement non palliatif, Méthode invasive
Mots-clés Pascal anglais : Malignant tumor, Metastasis, Dementia, Advanced stage, Terminal stage, Hospital environment, Treatment, Diagnosis, Elderly, Human, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0483354
Code Inist : 002B30A03B. Création : 10/04/1997.