Menos del 11% de los médicos optarían por la RCP para sí mismos

Menos del 11% de los médicos optarían por la RCP para sí mismos

In Advanced Cancer or End-Stage Alzheimer’s

In June, the Journal of Medical Ethics published a landmark survey of physicians.¹ The survey reveals that almost all physicians would prefer palliative care over curative treatments in cases of advanced cancer or end-stage Alzheimer’s. Only one half of one percent of physicians said they would choose CPR if they had advanced cancer. Even less, one fifth of one percent of physicians, said they would choose CPR if they had end-stage Alzheimer’s. While these results in and of themselves are not surprising, the juxtaposition of this finding and how patients experience end-of-life care has raised questions. Moreover, this study may offer a powerful tool when doctors discuss treatment for terminal disease in an advanced state. Doctors and other care planners can now share, “Less than 1% of doctors would choose life-prolonging attempts in this situation. The majority would prioritize comfort care.”

Of course, the question this raises is how can these survey findings be accurate while a high percentage of non-physician patients receive aggressive treatment near death? Is it that physician knowledge about these situations is widely divergent from patient and family perceptions? Is there a communications gap? Are patients being educated about hospice as a care option within one year of a predictable death?

Ultimately, care driven by the values and preferences of the patient should be the priority. Individual and ongoing consultation determines value-concordant care, but surveys of decedents give us some red flags to watch for. Glass et al. found that higher healthcare spending at the end of life correlates with a lower likelihood of goal-concordant care.² Haines et al. found that advance care planning was one of the strongest predictors of concordant care and that being African American independently decreased the likelihood of goal-concordant care (odds ratio 0.73).³ On the other hand, Khandelwal et al. found no demographic factor predicted inconsistent care. The only predictor detected by their study was site of care.⁴ End-of-life care delivered at home was significantly more likely to be described as consistent with wishes. When advance care planning is clearly documented in a patient’s records, home is much more likely to be the site of end-of-life care.⁵

A family’s preference for curative measures over hospice may be driven by a belief that curative measures are more likely to extend life while palliative measures are more likely to shorten it. Countering this misconception, research shows that when doctors estimate that no curative measure will extend life beyond six months, choosing palliative care (especially home-based hospice) correlates with longer survival than choosing curative care.^6-11

In closing, bridging the gap between what physicians would choose for themselves and what patients often experience may come down to communication, timing, and perception. Discovering and addressing misconceptions about “giving up” versus “surviving” may prove to be effective steps in aligning patient care with informed medical judgment. When care planners initiate advance care planning early and present clear information (such as, “Less than 1% of doctors would choose life-prolonging attempts in this situation; the majority would prioritize comfort care”), they give patients and families an opportunity to step back from misconceptions and take a fresh and informed look at their alternatives. In this way, well-timed, compassionate dialogue may be the most effective prescription for value-concordant care.

At Avatar Home Health & Hospice, we see this gap every day—and we believe it can be closed with earlier conversations, clearer expectations, and compassionate guidance that protects both dignity and quality of life. Our hospice and palliative teams partner with physicians to support goal-concordant care through timely referrals, thorough symptom management, and family education that reduces fear and confusion at the bedside. When the plan is clear and comfort becomes the priority, patients are more likely to remain at home, avoid unwanted escalation, and experience end-of-life care that reflects informed medical judgment as well as the patient’s values.

Please tell your patients about Avatar Home Health & Hospice

Referencias

1. Mroz S, Dierickx S, Chambaere K, Mortier F, De Panfilis L, Downar J, Lapenskie J, Anderson K, Skold A, Campbell C, Campbell TC. Physicians’ preferences for their own end of life: a comparison across North America, Europe, and Australia. Journal of Medical Ethics. 2025 Jun 10.
2. Glass DP, Wang SE, Minardi PM, Kanter MH. Concordance of end-of-life care with end-of-life wishes in an integrated health care system. JAMA Network Open. 2021 Apr 1;4(4):e213053-.
3. Haines L, Rahman OK, Sanders JJ, Johnson K, Kelley A. Factors that impact family perception of goal-concordant care at the end of life. Revista de Medicina Paliativa. 2019 Aug 1;22(8):927-32.
4. Khandelwal N, Curtis JR, Freedman VA, Kasper JD, Gozalo P, Engelberg RA, Teno JM. How often is end-of-life care in the United States inconsistent with patients’ goals of care?. Revista de Medicina Paliativa. 2017 Dec 1; 20 (12): 1400-4.
5. Ashana DC, Chen X, Agiro A, Sridhar G, Nguyen A, Barron J, Haynes K, Fisch M, Debono D, Halpern SD, Harhay MO. Advance care planning claims and health care utilization among seriously ill patients near the end of life. JAMA Network Open. 2019 Nov 1; 2 (11): e1914471.
6. Hamano J, Takeuchi A, Mori M, Saitou Y, Yamaguchi T, Miyata N, Shimizu M, Yamamoto R, Kimura Y, Kamiyama Y, Arai Y. Comparación de los tiempos de supervivencia de pacientes con cáncer avanzado con cuidados paliativos en el hogar y en el hospital. Plos Uno. 13 de abril de 2023;18(4):e0284147.
7. Lai WS, Liu IT, Tsai JH, Su PF, Chiu PH, Huang YT, Chiu GL, Chen YY, Lin PC. Modelos de prestación de cuidados paliativos y diferencias de supervivencia en enfermos terminales: un estudio de cohorte amplio. BMJ Cuidados Paliativos y de Apoyo. 15 de diciembre de 2021;14(e1):e1134-43.
8. Murakami N, Kajiura S, Tanabe K, Tsukada K, Shibata K, Minabe Y, Morita T, Hayashi R. Alta a domicilio desde una unidad de cuidados paliativos: impacto en la supervivencia y factores asociados con la muerte en el domicilio después del alta: un estudio de cohorte. Cuidados paliativos de BMC. 30 de noviembre de 2023;22(1):191.
9. Pyenson B, Connor S, Fitch K. Costo de Medicare en cohortes emparejadas de hospicio y no hospicio. Manejo de los síntomas del dolor. 2004; 28: 200-210.
10. Huo J, Lairson D, Du X, et al. Supervivencia y rentabilidad de los cuidados paliativos para pacientes con melanoma metastásico. Revista estadounidense de atención médica administrada. 2014; 20 (5): 366-373.
11. Connor S, Pyenson B, Fitch K, et al. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. Manejo de los síntomas del dolor. 2007 Mar; 33(3): 238-46.