Many of our clients tend to think of hospice as a death sentence for their sick family members. Some look at it as the medical professionals "giving up" on treatment. Neither of these things is actually true. In reality, hospice care is not about giving up or giving in — it is about giving someone a better quality of life rather than simply more life. And in many cases, better quality of life leads to more life.
Here are some surprising facts about hospice care drawn from research by Atul Gawande published in The New Yorker Magazine. These studies jumped off the page when we read them — and we think you should know about them.
Researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. But curiously, hospice care seemed to extend survival for some patients — those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.
"People who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation — and to spare their family anguish."
In late 2004, Aetna started an experiment — allowing policyholders with a life expectancy of less than a year to receive hospice services without giving up other treatments. Patients could continue chemotherapy and radiation while also having a hospice team at home. The surprising result was that they did give up things voluntarily. They visited the emergency room almost half as often. Their use of hospitals and ICUs dropped by more than two-thirds. Overall costs fell by almost a quarter.
Among elderly patients in a related program, use of intensive care units fell by more than 85%. Satisfaction scores went way up. The program's leaders had the impression that they had simply given patients someone experienced and knowledgeable to talk to about their daily needs. And somehow that was enough — just talking.
Consider La Crosse, Wisconsin — whose elderly residents have unusually low end-of-life hospital costs. During their last six months, they spend half as many days in the hospital as the national average. By 1996, 85% of La Crosse residents who died had written advance directives, up from 15% — and doctors almost always knew of and followed them. Discussion had brought La Crosse's end-of-life costs down to just over half the national average. It was that simple — and that complicated.
The takeaway for families: having the conversation about end-of-life care — before a crisis forces it — matters enormously. Both for the patient's comfort and for the family's healing afterward.