Most Patients’ End-of-Life Care Wishes Are Met, Says Study Conducted by Kaiser Permanente Research Scientist in Pasadena

The vast majority of patients make their end-of-life care wishes known to loved ones, and nearly 90% of the time those wishes were carried out, according to a Kaiser Permanente study published Tuesday in the medical journal JAMA Network Open.

“There is a common perception that people don’t often document or tell others about their end-of-life wishes,” said the study’s lead author, David Glass, a research scientist at the Kaiser Permanente Southern California Department of Research & Evaluation and lecturer in the Department of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine.

“Our research showed that people shared their end-of-life wishes and that those wishes are typically met here at Kaiser Permanente Southern California,” he said.

Glass and his team surveyed the next-of-kin of 715 Kaiser Permanente members who died at age 65 or older. Survey participants reported that the vast majority of their loved ones had end-of-life discussions and got the care they preferred, he said, adding this was true for members with quite different end-of-life values. The next-of-kin of those who wanted physicians to “do everything” to save a life and of those who preferred a less intrusive approach to end-of-life care reported that those wishes had been met.

“We found it particularly interesting that 83% of next-of-kin reported that their loved one received the right amount of care,”  Glass said.

“In short, neither `overtreatment’ nor `undertreatment’ was perceived by most of those who responded to our survey.”

Specifically, next-of-kin reported that:

• 94% of decedents did not receive an unwanted treatment;

• 89% of decedents had their end-of-life wishes met;

• 85% of decedents died in the way that they wanted to;

• 84% of decedents filled out an advance directive, a legal document that provides guidance for health care decisions in case the person can’t make those decisions for themselves;

• 83% of decedents had a discussion with next-of-kin about their end-of-life care and treatment preferences; and

• 83% received the “right amount” of care.

The study also showed that those who incurred the highest costs were less satisfied than those who had lower costs, according to Glass. while “at first glance this might seem counterintuitive, in a closer look, we discovered this higher cost group had died at a younger age than the lower cost group,” he said. “So, it may well be that the dissatisfaction of the high cost group reflected a disappointment that despite all the efforts and costs, death came earlier than was expected.”