University of NSW medical research team leads study of end-of-life treatment

Health researcher: Magnolia Cardona-Morrell led a university study into the care of elderly patients.

Health researcher: Magnolia Cardona-Morrell led a university study into the care of elderly patients.

A study of the care of elderly patients hospitalised at the end of their life reveals more than a third received invasive and potentially harmful medical treatments.

The largest systematic review led by researchers from the University of NSW across two decades is based on data from 1.2 million patients, relatives and clinicians across 10 countries including Australia.

Researchers found that the practice of doctors who initiated excessive medical or surgical treatment on elderly patients in the last six months of their life continued in hospitals worldwide.

The study calls for better training for hospital doctors and greater community education to reduce the demand for non-beneficial treatments.

It comes in the lead-up to Dying to Know Day on August 8, an annual day of action dedicated to bringing to life conversations and community actions around death, dying and bereavement. 

Bonnet Bay’s Magnolia Cardona-Morrell, a senior research fellow from the university’s faculty of medicine, led the research at the university’s Simpson Centre for Health Services Research.

She said rapid advances in medical technology fuelled unrealistic community expectations of the healing power of hospital doctors and their ability to ensure patients’ survival.

“It is not unusual for family members to refuse to accept the fact that their loved one is naturally dying of old age and its associated complications and so they pressure doctors to attempt heroic interventions,” she said.

“Doctors also are torn by the ethical dilemma of delivering what they were trained to do – save lives, versus respecting the patient’s right to die with dignity.”

The study revealed that 33 per cent of elderly patients with advanced, irreversible chronic conditions were given non-beneficial interventions including admission to intensive care or chemotherapy in the last two weeks of life, while others who had not-for-resuscitation orders were given CPR.

Researchers also found evidence of invasive procedures, unnecessary imaging and blood tests, intensive cardiac monitoring and concurrent treatment of other multiple acute conditions with complex medications that made little or no difference to the outcome, but which could prevent a comfortable death for patients.

“Our findings indicate the persistent ambiguity or conflict about what treatment is deemed beneficial and a culture of ‘doing everything possible’,” Dr Cardona-Morrell said.

“The lack of agreed definitions in the medical community of what constitutes ‘treatment futility’ also makes a global dialogue challenging.”

She said the data showed that non-beneficial medical treatments administered to elderly people in terminal stages of disease that prolonged suffering rather than survival and could potentially cause harm, were sometimes given against patients’ wishes, and were unlikely to improve the person’s health or quality of remaining life.

“More importantly, we identified measurable indicators and strategies to minimise this type of intervention,” Dr Cardona-Morrell said.

“An honest and open discussion with patients or their families is a good start to avoid non-beneficial treatments.”

Researchers also wrote a report about supportive and palliative care to help doctors and caregivers more accurately identify elderly patients whose death was imminent and unavoidable at the time of hospital admission. 

Dr Cardona-Morrell said as the elderly and frail population grew, the number of attendances to emergency rooms and admissions to acute hospitals was expected to increase.

“More training for doctors will help them let go of the fear of a wrong prognosis, because they will be better able to identify patients near the end of life,” she said.

The global analysis of 38 studies included participants from Canada, England, France, Holland, Brazil, Taiwan, South Korea and Israel.

The research was supported by a grant from the National Health and Medical Research Council of Australia and published in the International Journal for Quality in Health Care.