When it comes to making decisions about aggressive medical treatments for the terminally ill, a recent study suggests that if quality of life is the goal, less is actually more. The study, published Aug. 13, 2012 in The Archives of Internal Medicine followed 396 cancer patients from 2001-2008.
Patients and their caregivers enrolled in the Coping With Cancer study were asked what factors most influenced their quality of life at the end of life.
They identified nine factors:
- Intensive care stays
- Hospital deaths
- Patient worry
- Religious prayer or meditation
- Site of care
Feeding tube use in the final week
Pastoral care in the hospital
- Chemotherapy in the final week
- Relationship between patients and their doctors
“There’s almost a dose-response relationship between aggressive medical procedures—like feeding tubes, ventilators and resuscitation—and impaired quality of life in the last week,” Holly Prigerson, a psychologist at Dana Cancer Institute in Boston told Cancer Today.
“The single most important factor was whether a patient spent the final week intensive care unit (ICU) or at home.”
Prigerson said that a strong doctor-patient relationship is one of the most important factors contributing to a better quality of life. “Patients don’t want to feel abandoned when there is no more medical treatment to give.”
Just as interpersonal relationships and support are important, so too is spiritually, according to the study. Patients who self-identified as being spiritual and incorporated their spirituality reported a sense of peacefulness at the end of life.
The study shines light on the importance of advanced planning. End-of-life care is extremely personal and varies a great deal between individuals.
If you want to live as long as possible or avoid an ICU death, your advanced care goals can’t be carried out if your doctors and family don’t know what your goals are.