RT Journal
A1 Hanson LC, Earp J, Garrett J, Menon M, Danis M
T1 COmmunity physicians who provide terminal care
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD May 24
VO 159
IS 10
SP 1133
OP 1138
DO 10.1001/archinte.159.10.1133
UL http://dx.doi.org/10.1001/archinte.159.10.1133
AB Background 
    Most dying patients are treated by physicians in community practice, yet studies of terminal care rarely include these physicians.Objective 
    To examine the frequency of life-sustaining treatment use and describe what factors influence physicians' treatment decisions in community-based practices.Methods 
    Family members and treating physicians for decedents 65 years and older who died of cancer, congestive heart failure, chronic lung disease, cirrhosis, or stroke completed interviews about end-of-life care in community settings.Results 
    Eighty percent of eligible family and 68.8% of eligible physicians participated (N=165). Most physicians were trained in primary care and 85.4% were primary care physicians for the decedents. Physicians typically knew the decedent a year or more (68.9%), and 93.3% treated them for at least 1 month before death. In their last month of life, 2.4% of decedents received cardiopulmonary resuscitation, 5.5% received ventilatory support, and 34.1% received hospice care. Family recalled a discussion of treatment options in 78.2% of deaths. Most discussions (72.1%) took place a month or more before death. Place of death, cancer, and having a living will were independent predictors of less aggressive treatment before death. Physicians believed that advanced planning and good relationships were the major determinants of good decision making.Conclusions 
    Community physicians use few life-sustaining treatments for dying patients. Treatment decisions are made in the context of long-term primary care relationships, and living wills influence treatment decisions. The choice to remain in community settings with a familiar physician may influence the dying experience.