Third of dy­ing pa­tients suf­fer ‘in­va­sive’ care

Un­help­ful or harm­ful treat­ment given at end of life as re­la­tions ex­pect too much from doc­tors

The Daily Telegraph - - News - By Laura Don­nelly HEALTH ED­I­TOR

MORE than a third of dy­ing el­derly pa­tients re­ceive “in­va­sive and po­ten­tially harm­ful” treat­ments in their last weeks of life, the big­gest re­view of its kind has found.

Anal­y­sis of data from 1.2 mil­lion pa­tients world­wide found some were be­ing sub­jected to “ex­ces­sive” and un- nec­es­sary treat­ments that made no dif­fer­ence to the course of their ill­ness.

Re­searchers said part of the is­sue was fam­i­lies who strug­gled to ac­cept that noth­ing more could be done for their loved ones, and who ex­pected “heroic” in­ter­ven­tions from doc­tors.

The re­view, led by the Uni­ver­sity of New South Wales in Aus­tralia, in­volved 10 coun­tries, in­clud­ing Eng­land. It found around a third of el­derly pa­tients with ad­vanced, ir­re­versible con­di­tions such as can­cer were given treat­ments that were of no ben­e­fit to them.

One third of ter­mi­nally ill can­cer pa­tients were given chemo­ther­apy in the last six weeks of life, while 10 per cent of all pa­tients in ir­re­versible de­cline were ad­mit­ted to in­ten­sive care units.

A third of such pa­tients were given an­tibi­otics and heart medicines, while al­most as many were put through dial­y­sis, blood trans­fu­sions or other life sup­port. A quar­ter of pa­tients who had Do Not Re­sus­ci­tate or­ders in their notes were re­sus­ci­tated, while up to half of such pa­tients un­der­went in­va­sive blood tests and scans, the study found.

Dr Mag­no­lia Car­dona-Mor­rell, who led the re­search, said ad­vances in medicine had led to “un­re­al­is­tic” ex­pec­ta­tions. She said: “It is not un­usual for fam­ily mem­bers to refuse to ac­cept the fact that their loved one is nat­u­rally dy­ing of old age and its as­so­ci­ated com­pli­ca­tions and so they pres­sure doc­tors to at­tempt heroic in­ter­ven­tions.”

Doc­tors were “torn by the eth­i­cal dilemma” that they were trained to save lives, in­stead of fo­cus­ing on the pa­tient’s right to die with dig­nity, she said, adding that non-ben­e­fi­cial treat­ments were those which “pro­long suf- fer­ing rather than sur­vival, that can po­ten­tially cause harm, and are some­times given against pa­tients’ wishes”.

Prof Bill Noble, med­i­cal direc­tor at the ter­mi­nal ill­ness char­ity Marie Curie, said: “Tele­vi­sion and film is of­ten guilty of de­pict­ing medicine as a heroic bat­tle rather than some­thing that’s fa­cil­i­tat­ing a nat­u­ral life­span. This damaging por­trayal per­pet­u­ates the un­re­al­is­tic ex­pec­ta­tions about what doc­tors can do for pa­tients, es­pe­cially those with ter­mi­nal ill­nesses who might be ap­proach­ing the end of their lives.”

The study was pub­lished in the In­ter­na­tional Jour­nal for Qual­ity in Health Care.

‘It is not un­usual for fam­ily mem­bers to refuse to ac­cept the fact that their loved one is nat­u­rally dy­ing of old age’

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