Nearly 40 percent of chronic illness patients nearing the end of life who had physician orders limiting treatment received intensive care that was inconsistent with those orders, according to a study published in the Journal of the American Medical Association.
Patients with chronic illness frequently use physician orders for life-sustaining treatment to document their wishes with regard to end-of-life care.
For the study, researchers examined 1,818 chronic illness patients at a two-hospital academic health system who died between Jan. 1, 2010, and Dec. 31, 2017. The patients were hospitalized for up to six months before they died.
Of the 1,818 patients:
- 401 had physician orders for "comfort measures only"
- 761 had orders for "limited additional interventions"
- 656 had orders for full treatment
Researchers found 31 percent of patients with comfort-only orders, 46 percent of patients with limited-interventions orders and 62 percent with full-treatment orders were admitted to the intensive care unit.
Among patients with comfort-only and limited-interventions order, 38 percent received ICU care not in line with their orders.
Researchers also found patients admitted for traumatic injury were significantly more likely to receive care not in line with their orders, but cancer patients were more likely to receive care in line with their physician orders.