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Physicians can involve additional people in the care of terminally ill patients to ensure their quality of life doesn’t deteriorate in their final days, according to a study by Mayo Clinic researchers. The study authors note physicians as a group may prolong end-of-life suffering with aggressive approaches to "cure" the patients’ underlying disease rather than acknowledging the time has come to provide the patient with palliative care services.
However, strategies can be taken to reduce the suffering of a patient by orchestrating a multidimensional approach to helping ensure the quality of life at the end. The special article, done for the Mayo Clinic Cancer Center Quality of Life Working Group, appears in Mayo Clinic Proceedings.
Before the 1900s, most Americans died at home surrounded by their loved ones. Currently, as many as 60% will die in hospitals, and up to an additional 25% will die in health care-related facilities such as nursing homes. Physicians have had an ever-expanding role in the manner in which people die, with so many Americans dying in hospitals and other health care facilities.
"With modern medicine emphasizing genetic manipulations, high technology, and cure at all costs, we often neglect what was once the most sacred aspect of being a physician: alleviating suffering," the authors wrote. "Therefore, we contend that the approach to a person dying in the hospital must change from simply postponing death to focusing medical interventions on maintaining quality of life to the end."
The authors defined the term "quality of life" as the physical, psychological, social, and spiritual domains of health that are influenced by a person’s experiences, beliefs, expectations, and perceptions.
The Mayo Clinic authors conclude their article: "We believe that the principles that have been so successful in improving the quality of life for hospice patients must be adopted in hospitals and related facilities such as nursing homes so that suffering can be relieved where the vast majority of Americans continue to die."
• Rummans TA, et al. Maintaining quality of life at the end of life. Mayo Clinic Proc 2000; 75:1,305-1,310.