That’s the finding of a recent report by the Dartmouth Atlas Project.

Researchers found that since 2007, chronically ill Medicare patients spent less time in the hospital and received more hospice care than they did in 2003. Even so, those patients generally received more intense medical care, including more time in intensive care units and more visits from specialists.

The researchers said the capacity growth of intensive care and other specialties may be the driver behind the more aggressive care.

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In particular, those facing life-ending illnesses such as cancer, heart failure and dementia, are subjected to drawn-out procedures that may be counter-productive and create a miserable environment for patients in their final days. Consider:

• Hospitalizations during the last six months of life increased by more than 10% between 1996 and 2005.
• Average time spent in hospice care or other palliative treatment is shorter, because patients are getting aggressive treatment up until the very end. (One-third of hospice patients received it for less than one week, according to one study.)
• As many as 20% of cancer patients receive four or more sequential treatments of chemotherapy, even though  guidelines call for no more than three attempts if the tumors haven’t responded to treatment.

The reasons for this over-treatment are complex – but understandable.

Many doctors practice “exhaustion medicine” – trying any treatment regardless of likelihood of its success, until there are no options left. Doctors may revert to this out of a fear of lawsuits later on, or simply because it’s difficult to convince a patient in denial that his or her condition is simply not treatable and won’t improve.

Doctors don’t share all the blame for overtreatment. Patients may have little to hold on to besides the hope of getting better – and if a treatment has only a 1% chance of working, that 1% chance may seem preferable to waiting for death.

But overtreatment has numerous downsides: It not only saps the sorely needed resources of an already-strained health care system, it subjects patients and their families to unnecessary pain and discomfort – both physical and emotional.

Ethics experts and others in hospice and palliative care urge health care providers to make time with patients, especially those diagnosed with cancer, dementia and heart failure, to discuss the true pros and cons of aggressive treatment past a certain point. The earlier, the better.

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The data comes from a recent study by Holly Prigerson at the Dana-Farber Cancer Institute. The study followed 302 patients until their deaths and reviewed both their stated care preferences and the actual care they received.

Granted, the study was small, but some key differences in how white and black patients were treated emerged.

In general, black patients were far more likely to get aggressive end-of-life treatment. But, among patients who had specifically requested aggressive care, white patients were three times more likely to actually receive it.

The opposite was true among patients who stated they did not want aggressive treatment, or who signed DNRs: None of the white patients with DNRs received aggressive treatment, but several of the black patients did.

The report, published in the Journal of Clinical Oncology, suggested that at least some of the disparity in treatment can be explained by less effective communication among the caregivers of the black patients. Black patients were more likely to be transferred to other facilities, and in those cases, communication gaps may have developed.

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