“Mission Creep” in End of Life Care?
The Washington Post ran an article recently that looked at the provision of treatments to those who are at the end of life. Mission creep doesn’t benefit patients at the end of life explains
Here in America, there is a deeply held belief that advances in medicine will eventually conquer or cure the chronic scourges of cancer, dementia, heart disease, lung disease and diabetes. This notion leads many elderly patients to seek aggressive treatment not only to spare their loved ones grief but because they hope (and expect) to be cured, if only they hold on just a little longer.
So how often is futile care provided? And why? The story reports “more than 75,000 people older than 85 die in intensive care units seeking care that proves to be futile, according to a 2004 study. More than 65 percent of our senior citizens die in institutions when a significant majority say they would prefer to die at home, according to a 2014 report by the Institute of Medicine.” So what does the author mean by “mission creep” when patients make choices?
Not every patient has the option to decline surgery for a threatening aneurysm or chemotherapy for late-stage cancer. Most patients have multiple smaller decisions to make in the mission creep of treatment vs. care. These patients and their families need help thinking about the natural progression of aging and visualizing what they want at the end. Then, if they decline treatment and choose palliative care, they can consider an exit strategy.
So oversimplified, this boils down to a quality vs. quantity discussion. The author recommends that when the patient is an elder, “that conversation should include a discussion about futile treatments vs. making sure the last days on earth are comfortable….” and that “discussions with our trusted physicians should evolve from how to die later to how to die better, including with an exit strategy.”
~Thanks to Rebecca C. Morgan