System-Level Influences on Overly Aggressive Treatments at the End of Life

Dzeng, Elizabeth, Daniel Dohan, et al. 
Homing in on the Social: System-Level Influences on Overly Aggressive Treatments at the End of Life
Journal of Pain and Symptom Management , Volume 55 , Issue 2 , 282 - 289

DOI: https://doi.org/10.1016/j.jpainsymman.2017.08.019

A good end-of-life experience—a death free from avoidable suffering and distress for patients and their loved ones and aligned with patients' preferences—remains elusive. Although the majority of Americans want to die comfortably at home rather than hospitalized on life support, the medical system defaults to aggressive care for the terminally ill. Despite advances in palliative care, the past decade has seen increased intensive care unit (ICU) use and health care transitions in the last month of life. Compared with a decade ago, patients with advanced dementia are twice as likely to receive mechanical ventilation without substantial improvement in survival.