Tuesday, October 11, 2005

Effects of defining a patient as "terminal"

J Clinical Oncology has pre-released an article on-line about the effects of defining cancer patients as 'terminal.'  It looks at a Danish population of deceased cancer patients and compares those who were labelled 'terminal' vs. those who weren't.  Apparently, in Denmark, a physician can make a 'terminal declaration' about a patient--that they have less than 6 months to live.  With the terminal declaration a patient can get increased reimbursement for medication expenses, home care services, and informal caregivers can receive compensation (so, akin to the timing of hospice referral in the US, the timing of the terminal declaration may have as much to do with specific patient/caregiver needs as with actual recognition on the part of the patient or physician about the terminal nature of the illness).  Essentially, the authors looked at everyone in an area who died of cancer & compared those with the official terminal declaration vs. those without.  They found a few differences in the groups based on type of cancer etc. as well as a marked difference in rate of hospitalization and place of death (39% of terminal diagnosis patients died in a hospital vs. 65% of those without).  This is, unfortunately, as far as they looked.  Obviously there are major problems here--not least being that probably some significant portion of the "non-terminal-declaration" patients weren't terminally ill prior to an acute event that killed them.  However this article struck me because 1) this terminal declaration business is potentially a mother-lode of information & one hopes these Danish researchers & others keep mining it & 2) it's another drop in the bucket of information suggesting that defining the dying early, referring dying people for services early (hospice or otherwise) is beneficial to our patients.

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