Bereaved Family More Likely to Report "Too Little" Care Than "Too Much" Care at the End of Life

Background

An often-stated concern is that dying persons receive too much aggressive medical care.

Objective

Examine next-of-kin perceptions of the amount of medical care received in the last month of life.

Design

Mixed-methods study with 623 survey responses and in-depth interviews with a subsample of 17 respondents.

Subjects

Nontraumatic deaths 18 years and older in San Francisco Bay area.

Measure

The survey asked: "During the last month of your family member's life, did he or she receive too little, the right amount, or too much medical care?" Additionally, surveys examined 18 measures of quality of care in the last month of life, reporting concerns or unmet needs with staff communication, symptom management, emotional support, physician communication, treating the patient with dignity, respecting a person's culture, spiritual support, and providing timely help after hours.

Results

Of the 623 survey respondents, 16.9% reported their loved one received "too little" care while only 1.4% reported "too much." Likelihood of reporting too little medical care did not differ by age, gender, or being insured by Medicaid only. Respondents who reported "too little" compared with those that stated the "right amount" reported higher unmet needs for symptom palliation, physician communication concerns, with other important opportunities to improve the quality of care. Among the 17 in-depth interviews of those indicating "too little" care on the structured survey, the predominant concern (n = 10) was inadequate symptom management.

Conclusion

While the majority of respondents indicated their loved one received the right amount of medical care at the end of life, a notable minority (one in six) indicated that their loved one received too little care.