Less can be more at the end of life
Advances in medicine mean health care professionals can prolong life, yet some treatments have a low chance of providing tangible benefits to some patients, can result in a 'bad death' and represent a multi-million dollar cost to the public purse.
The Australian-first Reducing Non-Beneficial Treatment at the End-of-Life collaboration between QUT health and law researchers has been awarded a $504,187.80 Partnership Grant from the National Health and Medical Research Council. Three hospital partners are investing a similar amount.
Chief Investigator Professor Nick Graves from QUT's Faculty of Health and Academic Director of the Australian Centre For Health Services Innovation (AusHSI), said prolonging an individual's death with 'futile' or 'non-beneficial' treatment could both increase suffering and waste money.
"Such treatments, which are pervasive in the health system, do not help patients who are dying, and cost the tax payer a lot of money. Programs to reduce their frequency should be developed and subject to research," said Professor Graves, who is based at QUT's Institute of Health and Biomedical Innovation.
"Doctors provide treatment they perceive as non-beneficial for various reasons yet these treatments cause clinicians moral distress and increase the risk of a 'bad' death by prolonging or increasing patient suffering.
"Our project aims to increase awareness among hospital clinicians of the extent of non-beneficial treatment at the end-of-life and stimulate action to reduce the problem, as well as improve end-of-life care."
Professor Graves added the project builds on an earlier collaboration between QUT health researchers and law Professors Lindy Willmott and Ben White from QUT's Australian Centre for Health Law Research, where they, with researchers from the University of Queensland, identified reasons why doctors sometimes provide treatment they know to be futile.
That research measured incidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with those treatments and the monetary value of bed days involved.
They found the incidence rate of futile treatment in end-of-life admissions was 12.1% across the three study hospitals. The cost associated with futile bed days was estimated to be $A12.4 million using health system costs, and $A988 000 when using a decision maker's willingness to pay for bed days. This was extrapolated to an annual national health system cost of $A153.1 million.
"An increased awareness of these economic costs may generate support for interventions designed to reduce futile treatments. We did not include emotional hardship or pain and suffering, which represent additional costs," said Professor Willmott.
"This new partnership takes the research one step further by seeking to reduce the provision of futile or non-beneficial treatment.
"It will allow hospitals to improve services at the end of life, free up hospital bed days and improve outcomes for patients and families. The connections made with health services and policy groups by the partnership will improve the likelihood of changing practice."
The project partners are QUT, Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association, Palliative Care Australia, Gold Coast University Hospital and Metro North Hospital and Health Service – The Royal Brisbane and Women's Hospital & the Prince Charles Hospital.
The collaboration incudes researchers from QUT, UNSW, the University of Adelaide and UQ.