Association between aggressive care and bereaved families’ evaluation of end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs facilities

In Cancer, Mary Ersek and colleagues, including Bruce Kinosian, assess the relationship between aggressive end-of-life care and patient and family satisfaction. The authors focused on patients requiring an episode of aggressive care (such as chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life among patients with non-small cell lung cancer who died in a Veterans Affairs facility. They used data including Veterans Affairs administrative and clinical data, Medicare claims, and the Bereaved Family Survey. They find that bereaved families of patients receiving aggressive care rated care lower than families of patients who did not receive aggressive care. However, this did not hold true for patients in a hospice/palliative care unit (HPC); for patients dying in an HPC unit, the associations between overall ratings of care and episodes of aggressive care were not statistically significant. The authors conclude that aggressive care within the last month of life is associated with lower family evaluations of end-of-life care. However, specialized care within an HPC unit may mitigate the negative effects of aggressive care.