Among family members of older fee-for service Medicare patients who died of colorectal or lung cancer, earlier hospice enrollment, avoidance of intensive care unit (ICU) admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better end-of-life care, according to a study published in JAMA.1

Although patients with advanced-stage cancer receive increasingly aggressive medical care near death, there are growing concerns that this approach reflects poor-quality care. Therefore, researchers sought to evaluate the association between aggressive end-of-life care and bereaved family members’ perceptions of the quality of end-of-life care and patients’ goal attainment.

For the study, researchers interviewed 1156 family members of Medicare patients with advanced-stage colorectal or lung cancer. Results showed that 51.3% of bereaved members reported excellent end-of-life care and more often reported excellent care for patients who received hospice care for longer than 3 days compared with those who received 3 or fewer days.

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Furthermore, researchers found that excellent end-of-life care was reported for patients who were admitted to an ICU within 30 days of death less often than patients who were not admitted to ICU within 30 days of death. Similarly, family members of patients who died in the hospital were less likely to report excellent end-of-life care than those who did not die in the hospital.

“These findings are supportive of advance care planning consistent with the preferences of patients,” the authors conclude.


1. Wright AA, Keating NL, Ayanian JZ, et al. Family perspectives on aggressive cancer care near the end of life. JAMA. 2016;315(3):284-292.