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Community physicians who provide terminal care.
L C Hanson1, J A Earp, J Garrett
1Division of General Internal Medicine, University of North Carolina at Chapel Hill, 27599-7110, USA. lhanson@med.unc.educ
Archives of Internal Medicine
|May 21, 1999
Summary
Community physicians rarely use life-sustaining treatments for dying patients. Long-term relationships and advance care planning, like living wills, significantly influence end-of-life treatment decisions.
Area of Science:
- Palliative Care
- Oncology
- Geriatrics
Background:
- Most dying patients receive care from community-based physicians, yet these providers are often excluded from end-of-life care research.
- Understanding their practices is crucial for improving terminal care outcomes.
Purpose of the Study:
- To determine the frequency of life-sustaining treatment (LST) utilization in community practices.
- To identify factors influencing physicians' end-of-life treatment decisions.
Main Methods:
- Interviews were conducted with family members and treating physicians of decedents aged 65+ who died from major chronic illnesses.
- Data collection focused on end-of-life care experiences in community settings.
Main Results:
- Eighty percent of eligible families and 68.8% of physicians participated (N=165).
- LST use was low: cardiopulmonary resuscitation (2.4%), ventilatory support (5.5%). Hospice care was used in 34.1% of cases.
- Advance care planning discussions occurred in 78.2% of deaths, often more than a month prior. Living wills, place of death, and cancer diagnosis independently predicted less aggressive treatment.
Conclusions:
- Community physicians utilize limited life-sustaining treatments for terminally ill patients.
- End-of-life treatment decisions are shaped by established primary care relationships and advance directives.
- The continuity of care within community settings may positively impact the patient's dying experience.