Cited by 898Palliative Care and End-of-Life IssuesPalliative and Oncologic CareEconomic and Financial Impacts of Cancer

The DOI matches its Crossref record; 21 of the 21 references it cites were found in a registry or an index; none of the 12 sources its claims cite is checked for support yet.

Health Care Costs in the Last Week of Life: Associations With End-of-Life Conversations

Open access

Abstract

BACKGROUND: Life-sustaining medical care of patients with advanced cancer at the end of life (EOL) is costly. Patient-physician discussions about EOL wishes are associated with lower rates of intensive interventions. METHODS: Funded by the National Institute of Mental Health and the National Cancer Institute, Coping With Cancer is a longitudinal multi-institutional study of 627 patients with advanced cancer. Patients were interviewed at baseline and were followed up through death. Costs for intensive care unit and hospital stays, hospice care, and life-sustaining procedures (eg, mechanical ventilator use and resuscitation) received in the last week of life were aggregated. Generalized linear models were applied to test for cost differences in EOL care. Propensity score matching was used to reduce selection biases. RESULTS: Of 603 participants, 188 (31.2%) reported EOL discussions at baseline. After propensity score matching, the remaining 415 patients did not differ in sociodemographic characteristics, recruitment sites, illness acknowledgment, or treatment preferences. Further analyses, adjusted by quintiles of propensity scores and significant confounders, revealed that the mean (SE) aggregate costs of care (in 2008 US dollars) were $1876 ($177) for patients who reported EOL discussions compared with $2917 ($285) for patients who did not, a cost difference of $1041 (35.7% lower among patients who reported EOL discussions) (P =.002). Patients with higher costs had worse quality of death in their final week (Pearson production moment correlation partial r = -0.17, P =.006). CONCLUSIONS: Patients with advanced cancer who reported having EOL conversations with physicians had significantly lower health care costs in their final week of life. Higher costs were associated with worse quality of death.

Overview

Integrity signals

Registry

Crossref · 10.1001/archinternmed.2008.587

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

0 of 12 cited sources checked · 0 supported · 0 flagged

Show all 15 claims

  • It may state two separate claims as one. 13
  • Probably not a substantial claim. 5
  • The quote only partly states this claim. 1
17 of 17
  • The paper relies on this without support.

    The link between health care spending and patient-physician communication at the end of life has not been thoroughly studied.

    “To the best of our knowledge, the association between health care expenditures and patient-physician communication at the EOL has not been fully examined.”
  • The paper relies on this without support.

    Patients' self-report of having had an end-of-life discussion accurately indicates whether such a discussion took place.

    “EOL discussions were assessed at baseline by asking: “Have you and your doctor discussed any particular wishes you have about the care you would want to receive if you were dying?””
  • The paper relies on this without support.

    Reports from caregivers or nurses about the patient's quality of death accurately capture the patient's quality of life in the final week.

    “After the patients' death, caregivers both formal (i.e., paid clinicians such as nurses) and informal (i.e., unpaid caretakers such as spouses) were asked to assess the patients' quality of life in the period immediately prior to death e.g. “In your opinion, how would you rate overall quality of the patient's death/last week of life?””
  • The authors state this as an assumption.

    Patients and caregivers may place different values on care.

    “Additionally, we acknowledge that patients and caregivers may value care differently. Patients may consider extra dollars spent and more life-sustaining care worth the added expense whereas caregivers may devalue life-sustaining care.”
4 of 4

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported symptom scores exceed the stated scale maximum

    Minor

    The methods define the McGill symptom burden subscale as ranging from 0 to 10, but the results report group means of 10.4 and 12.0 on that subscale. A group mean cannot exceed the scale's maximum.

  • Overall symptom scores disagree across two partitions of the sample

    Minor

    The discussion groups partition the 603 patients into 188 and 415, giving an overall symptom mean of about 8.66 from the reported group means. The matched and unmatched groups also partition those 603 patients, but their reported means give an overall mean of about 11.34 for the same symptom subscale.

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Metadata

Authors
Zhang, B., Wright, A. A., Huskamp, H. A., Nilsson, M. E., Maciejewski, M. L., Earle, C. C., Block, S. D., Maciejewski, P. K., & Prigerson, H. G.
Affiliations
  • Dana-Farber Cancer Institute (US)
  • Harvard University (US)
  • University of North Carolina at Chapel Hill (US)
  • Brigham and Women's Hospital (US)
  • Yale University (US)
Venue
Archives of Internal Medicine
Published
2009-03-09
Volume
169
Issue
5
Pages
480
ISSN
0003-9926 (ISSN-L)
OpenAlex
W2169467289
Cited by
898
References
21
Citations by year
2026: 20 · 2025: 25 · 2024: 35 · 2023: 45 · 2022: 57 · 2021: 58 · 2020: 69 · 2019: 66 · 2018: 57 · 2017: 80 · 2016: 57 · 2015: 67 · 2014: 50 · 2013: 61 · 2012: 50
FWCI
49.41
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (MH-63892, R01MH063892)
  • National Cancer Institute (R01CA106370, CA106370)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
Keywords
end-of-life care, advanced cancer, health care costs, advance care planning, quality of death, intensive care utilization, hospice care, mechanical ventilation, resuscitation, last week of life
MeSH terms
Adult, Aged, Attitude to Death, Female, Humans, Male, Middle Aged, Neoplasms, Physician-Patient Relations, Quality of Life, Terminal Care, Health Care Costs

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