Virtually all doctors believe it's more important to alleviate suffering when someone is dying than to extend their life a little bit, according to a poll released by National Journal on Tuesday.
The poll of 500 board-certified physicians shows that 96 percent think quality of life for dying patients is more important than ensuring they live as long as possible. A similar number say the medical system needs to place a higher priority on easing the symptoms of patients if that's what they want.
Those results, rolled out at a National Journal Live event, show a contrast between doctors’ views and those of patients about palliative care at the end of life. In a February National Journal poll, a smaller majority—71 percent—of the general public who were asked the same question agreed with the doctors. Americans in general also differed from doctors on the question of whether the U.S. health care system spends too much trying to keep seriously ill patients alive as long as possible—37 percent of the public said it did, compared with 79 percent of doctors.
The health care system does spend a lot on care at the end of life. A 2004 study found that about 30 percent of Medicare's budget is devoted to the 5 percent of patients who die each year, with the majority of that money spent in the last month of their lives. Palliative care interventions, including hospice care, have been shown to lower the cost of caring for many patients.
Though the doctors said that ensuring quality of life at the end stage was important, they also identified barriers to achieving that goal. Nearly a quarter said they were uncomfortable discussing the subject with their patients. Twenty-four percent said that they were unprepared to discuss death. An identical number said they were reluctant to bring up palliative care because they were worried patients and their families would think they’d given up on them.
The poll also revealed a generation gap, one that suggests that the medical community has been working to improve doctors’ understanding of the importance of palliative care and planning for the end of life. For doctors 39 and under, 73 percent said they had at least some palliative-care training at medical school, compared with 36 percent of those 40-49, 23 percent of those 50-59 and 6 percent of doctors over 60.