A hundred years ago we did not need to worry about this… but when dying in the 21st century, overtreatment is possible, can add to disease burden, can decrease quality of life, and is in fact a concern that we need to address!
Article in NY Times by Tara Parker Pope, “Overtreatment is taking its toll” “When it comes to medical care, many patients and doctors believe more is better. But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system … and taking a human toll in pain, emotional suffering, severe complications and even death.”
In her book “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” Shannon Brownlee points out that more health care does not necessarily make one healthier, that some tests and procedures can actually do harm.
Research indicates that when substitute decision makers do not know a person is dying, they will err on the side of further acute agressive treatments, rather than on comfort care. Education is key to making informed choices.
One simple step to help decrease the burden of overtreatment is simply to provide individuals with adequate information in a way they can understand and comprehend the content, and then to support the patient/family to make informed decisions.
The Canadian Hospice Palliative Care Association (CHPCA) in the Model to Guide Hospice Palliative Care outlined the Process of Providing Care:
ASSESSMENT, followed by INFORMATION SHARING, then support to help patient and family with DECISION MAKING will help patient and family develop individualized, appropriate CARE PLANS, IMPLEMENTATION OF CARE and then CONFIRMATION or evaluation to see if the needs are being met.
It is possible that even with good information some people will chose many tests and procedures. But at least they will do so with information and while being supported in their decision making.
It is totally inappropriate to investigate, intervene, implement, push, prod, pull or puncture… without providing relevant information including the benefits and burdens.
For ideas on information sharing… stay tuned!
I just read an article on Ireland’s plan to cut health care for the elderly in order to deal with its deficit. I don’t know anything much at all about Ireland’s finances; but I wonder if it has considered the actual over-treatment of the dying, and that statics often claim that good palliative care lessens the overall ‘elder care’ costs. This is another reason for comprehensive and legal Advance Directives (which Ireland doesn’t have) — since the medically default position is aggressive treatment, Advance Directives will often request less treatment than that position.
I would also note that some of the groups I have talked raised the concern about health dollars being used for their treatment (to their mind, ‘over treatment’) that will not be available to their children and grandchildren. ‘Over treatment’ then is not just an emotional (or perhaps ethical) issues for these people, but also a financial one.