Featured Research

from universities, journals, and other organizations

Most physicians would forgo aggressive treatment for themselves at the end of life

Date:
May 28, 2014
Source:
Stanford University Medical Center
Summary:
Most physicians would choose a do-not-resuscitate or 'no code' status for themselves when they are terminally ill, yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, according to a study. It's a disconnect that needs to be better understood, said the lead author of the study. "Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn't choose it for ourselves?"

Most physicians would choose a do-not-resuscitate or "no code" status for themselves when they are terminally ill, yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, according to a study from the Stanford University School of Medicine to be published May 28 in PLOS ONE.

Related Articles


It's a disconnect that needs to be better understood, said VJ Periyakoil, MD, clinical associate professor of medicine and lead author of the study.

"Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn't choose it for ourselves?" said Periyakoil, director of the Stanford Palliative Care Education and Training Program. "The reasons likely are multifaceted and complex."

In the study, Periyakoil and her colleagues set out to determine how physicians' attitudes have changed toward advance directives since passage of the Self-Determination Act in 1990, a law designed to give patients more control over determining end-of-life-care decisions. Advance directives are documents that patients can use to indicate end-of-life care preferences.

The study involved two sets of subjects: One comprised 1,081 physicians who in 2013 completed a web-based advanced directive form and a 14-item advance directive attitude survey at Stanford Hospital & Clinics and the Veterans Affairs Palo Alto Health Care System; the other comprised 790 physicians from Arkansas who were asked the same 14 survey questions -- but did not complete an advance directive form -- in a 1989 study published in the Journal of the American Medical Association.

Surprisingly, results showed that doctors' attitudes toward advance directives have changed little in 25 years.

"The needle has not moved very much," Periyakoil said, who is also associate director of palliative care services at the Palo Alto VA center.

The lack of change in physicians' attitudes toward advance directives mirrors what the study describes as the medical system's continued focus on aggressive treatment at the end of life, despite the fact that most Americans now say they would prefer to die at home without life-prolonging interventions.

"A big disparity exists between what Americans say they want at the end of life and the care they actually receive," the study said. "More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden."

In fact, the type of treatments they receive depends not on the patients' care preferences or on their advance directives, but rather on the local health-care system variables, such as institutional capacity and individual doctors' practice style, according to the study.

"Patients' voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system," Periyakoil said.

Other results from the study showed that because of the Self-Determination Act, doctors now feel they are less likely to be sued for not providing the most aggressive care if a patient has an advance directive. The law requires hospitals to inform patients about advance directives, but it doesn't ensure that the directives be followed.

Physicians' attitudes toward end-of-life care also differed depending on their ethnicity and gender. Emergency physicians, pediatricians, obstetrician-gynecologists and those in physical medicine and rehabilitation had more favorable attitudes toward advance directives. Radiologists, surgeons, orthopaedists and radiation oncologists were less favorable. Caucasian and African American doctors were the most favorable; Latino physicians were the least favorable.

An overwhelming percentage of the 2013 doctors surveyed -- 88.3 percent -- said they would choose "no-code" or do-not-resuscitate orders for themselves.

As a geriatrics and palliative care physician who sits at the bedside of sick patients herself, Periyakoil said she understands the disconnect between the type of care doctors want for themselves at the end of life and what they actually do for their patients. It's not because doctors are trying to make more money or because they are intentionally insensitive to their patients' desires. At the core of the problem is a biomedical system that rewards doctors for taking action, not for talking with their patients.

"Our current default is 'doing,' but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself," said Periyakoil, who trains physicians in palliative medicine. "It's tricky, but physicians don't have to figure it out by themselves. They can talk to the patients and their families and to the other interdisciplinary team members, and it becomes much easier.

"But we don't train doctors to talk or reward them for talking. We train them to do and reward them for doing. The system needs to be changed."


Story Source:

The above story is based on materials provided by Stanford University Medical Center. The original article was written by Tracie White. Note: Materials may be edited for content and length.


Journal Reference:

  1. Vyjeyanthi S. Periyakoil, Eric Neri, Ann Fong, Helena Kraemer. Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives. PLoS ONE, 2014; 9 (5): e98246 DOI: 10.1371/journal.pone.0098246

Cite This Page:

Stanford University Medical Center. "Most physicians would forgo aggressive treatment for themselves at the end of life." ScienceDaily. ScienceDaily, 28 May 2014. <www.sciencedaily.com/releases/2014/05/140528180228.htm>.
Stanford University Medical Center. (2014, May 28). Most physicians would forgo aggressive treatment for themselves at the end of life. ScienceDaily. Retrieved December 21, 2014 from www.sciencedaily.com/releases/2014/05/140528180228.htm
Stanford University Medical Center. "Most physicians would forgo aggressive treatment for themselves at the end of life." ScienceDaily. www.sciencedaily.com/releases/2014/05/140528180228.htm (accessed December 21, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, December 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Touch-Free Smart Phone Empowers Mobility-Impaired

Touch-Free Smart Phone Empowers Mobility-Impaired

Reuters - Innovations Video Online (Dec. 21, 2014) A touch-free phone developed in Israel enables the mobility-impaired to operate smart phones with just a movement of the head. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com
Earthworms Provide Cancer-Fighting Bacteria

Earthworms Provide Cancer-Fighting Bacteria

Reuters - Innovations Video Online (Dec. 21, 2014) Polish scientists isolate bacteria from earthworm intestines which they say may be used in antibiotics and cancer treatments. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com
Existing Chemical Compounds Could Revive Failing Antibiotics, Says Danish Scientist

Existing Chemical Compounds Could Revive Failing Antibiotics, Says Danish Scientist

Reuters - Innovations Video Online (Dec. 21, 2014) A team of scientists led by Danish chemist Jorn Christensen says they have isolated two chemical compounds within an existing antipsychotic medication that could be used to help a range of failing antibiotics work against killer bacterial infections, such as Tuberculosis. Jim Drury went to meet him. Video provided by Reuters
Powered by NewsLook.com
Hugging It Out Could Help You Ward Off A Cold

Hugging It Out Could Help You Ward Off A Cold

Newsy (Dec. 21, 2014) Carnegie Mellon researchers found frequent hugs can help people avoid stress-related illnesses. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins