SOM Insights: Could better predictions improve end-of-life care?

A team of Yale researchers has developed a statistical tool that can improve predictions of whether patients with advanced cancer are likely to die in the near term. Their analysis suggests that better understanding of the end of life could promote patient welfare by transferring more people from aggressive interventions to hospice care. By Rachel Brody End-of-life care is among the most pressing issues in modern American health care. "We have a major issue with how we care for people at the end of life, particularly for patients with cancer," says Kerin Adelson, chief quality officer and deputy chief medical officer for Smilow Cancer Hospital at Yale-New Haven. Patients close to death are entering hospitals in "tremendously high numbers," she says, receiving aggressive, expensive and futile care, and dying there instead of in hospice, a less costly and more comfortable alternative. Why? Adelson says it's due in part to what she calls a "discrepancy in prognostic understanding." In other words, even patients with terminal illness often don't understand what's coming, and thus don't identify their goals and priorities for end-of-life care. Much of this has to do with overly rosy prognoses from physicians, a phenomenon Adelson says stems from two possible causes.