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End-of-Life Care Received by Physicians Compared With Nonphysicians

IMPORTANCE: The idea that physicians as patients choose less-aggressive care at the end of life for themselves is an often-cited rationale to advocate for less technology-laden end-of-life care. OBJECTIVE: To assess end-of-life care received by physicians compared with nonphysicians in a system with...

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Autores principales: Wunsch, Hannah, Scales, Damon, Gershengorn, Hayley B., Hua, May, Hill, Andrea D., Fu, Longdi, Stukel, Therese A., Rubenfeld, Gordon, Fowler, Robert A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659139/
https://www.ncbi.nlm.nih.gov/pubmed/31339549
http://dx.doi.org/10.1001/jamanetworkopen.2019.7650
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author Wunsch, Hannah
Scales, Damon
Gershengorn, Hayley B.
Hua, May
Hill, Andrea D.
Fu, Longdi
Stukel, Therese A.
Rubenfeld, Gordon
Fowler, Robert A.
author_facet Wunsch, Hannah
Scales, Damon
Gershengorn, Hayley B.
Hua, May
Hill, Andrea D.
Fu, Longdi
Stukel, Therese A.
Rubenfeld, Gordon
Fowler, Robert A.
author_sort Wunsch, Hannah
collection PubMed
description IMPORTANCE: The idea that physicians as patients choose less-aggressive care at the end of life for themselves is an often-cited rationale to advocate for less technology-laden end-of-life care. OBJECTIVE: To assess end-of-life care received by physicians compared with nonphysicians in a system with universal health care. DESIGN, SETTING, AND PARTICIPANTS: In this population-level decedent cohort study of data from April 1, 2004, through March 31, 2015 (fiscal years 2004-2014), in Ontario, Canada, 2507 physicians were matched approximately 1:3 to 7513 nonphysicians (ie, individuals who never were registered as a physician with the College of Physicians and Surgeons of Ontario) according to age, sex, income quintile, and location of residence. MAIN OUTCOMES AND MEASURES: The primary outcome was location of death. Other outcomes included measures of health care use in the last 6 months of life. Differences were assessed using Poisson regression with robust error variances, adjusting for the Charlson Comorbidity Index. RESULTS: In total, 2516 physicians and 954 836 nonphysicians died between April 1, 2004, and March 31, 2015, in Ontario; 2247 physicians (89.3%) and 474 182 nonphysicians (49.7%) were men. The median (interquartile range) age at death was 82 (74-87) years for the physicians and 80 (68-87) years for the nonphysicians. After matching, data for 2507 physicians and 7513 nonphysicians were analyzed. For physicians, the risk of death at home was no different from that for nonphysicians (42.8% vs 39.0%; adjusted relative risk [aRR], 1.04; 95% CI, 0.99-1.09), but the risk of death in an intensive care unit was increased (11.9% vs 10.0%; aRR, 1.22; 95% CI, 1.08-1.39). In the prior 6 months, physicians had a decreased risk of an emergency department visit (73.0% vs 78.4%; aRR, 0.96; 95% CI, 0.94-0.98) but increased risks of an intensive care unit admission (20.8% vs 19.1%; aRR, 1.14; 95% CI, 1.05-1.24) and of receipt of palliative care services (52.9% vs 47.4%; aRR, 1.18; 95% CI, 1.13-1.23). Among a subgroup of 457 physicians and 1347 nonphysicians with cancer, the risk of death at home or intensive care unit was increased (37.6% vs 28.6%; aRR, 1.30; 95% CI, 1.13-1.50), as was the risk of receiving chemotherapy in the last 6 months of life. CONCLUSIONS AND RELEVANCE: There was no difference overall for physicians compared with nonphysicians in terms of the likelihood of dying at home; physicians were more likely to die in an intensive care unit and to receive chemotherapy, but also to receive palliative care services. These findings suggest that physicians do not consistently opt for less-aggressive care but instead receive end-of-life care that includes both intensive and palliative care. These findings inform a more nuanced perspective of what physicians may perceive to be optimal care at the end of life.
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spelling pubmed-66591392019-08-07 End-of-Life Care Received by Physicians Compared With Nonphysicians Wunsch, Hannah Scales, Damon Gershengorn, Hayley B. Hua, May Hill, Andrea D. Fu, Longdi Stukel, Therese A. Rubenfeld, Gordon Fowler, Robert A. JAMA Netw Open Original Investigation IMPORTANCE: The idea that physicians as patients choose less-aggressive care at the end of life for themselves is an often-cited rationale to advocate for less technology-laden end-of-life care. OBJECTIVE: To assess end-of-life care received by physicians compared with nonphysicians in a system with universal health care. DESIGN, SETTING, AND PARTICIPANTS: In this population-level decedent cohort study of data from April 1, 2004, through March 31, 2015 (fiscal years 2004-2014), in Ontario, Canada, 2507 physicians were matched approximately 1:3 to 7513 nonphysicians (ie, individuals who never were registered as a physician with the College of Physicians and Surgeons of Ontario) according to age, sex, income quintile, and location of residence. MAIN OUTCOMES AND MEASURES: The primary outcome was location of death. Other outcomes included measures of health care use in the last 6 months of life. Differences were assessed using Poisson regression with robust error variances, adjusting for the Charlson Comorbidity Index. RESULTS: In total, 2516 physicians and 954 836 nonphysicians died between April 1, 2004, and March 31, 2015, in Ontario; 2247 physicians (89.3%) and 474 182 nonphysicians (49.7%) were men. The median (interquartile range) age at death was 82 (74-87) years for the physicians and 80 (68-87) years for the nonphysicians. After matching, data for 2507 physicians and 7513 nonphysicians were analyzed. For physicians, the risk of death at home was no different from that for nonphysicians (42.8% vs 39.0%; adjusted relative risk [aRR], 1.04; 95% CI, 0.99-1.09), but the risk of death in an intensive care unit was increased (11.9% vs 10.0%; aRR, 1.22; 95% CI, 1.08-1.39). In the prior 6 months, physicians had a decreased risk of an emergency department visit (73.0% vs 78.4%; aRR, 0.96; 95% CI, 0.94-0.98) but increased risks of an intensive care unit admission (20.8% vs 19.1%; aRR, 1.14; 95% CI, 1.05-1.24) and of receipt of palliative care services (52.9% vs 47.4%; aRR, 1.18; 95% CI, 1.13-1.23). Among a subgroup of 457 physicians and 1347 nonphysicians with cancer, the risk of death at home or intensive care unit was increased (37.6% vs 28.6%; aRR, 1.30; 95% CI, 1.13-1.50), as was the risk of receiving chemotherapy in the last 6 months of life. CONCLUSIONS AND RELEVANCE: There was no difference overall for physicians compared with nonphysicians in terms of the likelihood of dying at home; physicians were more likely to die in an intensive care unit and to receive chemotherapy, but also to receive palliative care services. These findings suggest that physicians do not consistently opt for less-aggressive care but instead receive end-of-life care that includes both intensive and palliative care. These findings inform a more nuanced perspective of what physicians may perceive to be optimal care at the end of life. American Medical Association 2019-07-24 /pmc/articles/PMC6659139/ /pubmed/31339549 http://dx.doi.org/10.1001/jamanetworkopen.2019.7650 Text en Copyright 2019 Wunsch H et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Wunsch, Hannah
Scales, Damon
Gershengorn, Hayley B.
Hua, May
Hill, Andrea D.
Fu, Longdi
Stukel, Therese A.
Rubenfeld, Gordon
Fowler, Robert A.
End-of-Life Care Received by Physicians Compared With Nonphysicians
title End-of-Life Care Received by Physicians Compared With Nonphysicians
title_full End-of-Life Care Received by Physicians Compared With Nonphysicians
title_fullStr End-of-Life Care Received by Physicians Compared With Nonphysicians
title_full_unstemmed End-of-Life Care Received by Physicians Compared With Nonphysicians
title_short End-of-Life Care Received by Physicians Compared With Nonphysicians
title_sort end-of-life care received by physicians compared with nonphysicians
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659139/
https://www.ncbi.nlm.nih.gov/pubmed/31339549
http://dx.doi.org/10.1001/jamanetworkopen.2019.7650
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