Importance: @entity1 with @entity5 are receiving increasingly aggressive medical care near @entity204 , despite growing concerns that this reflects poor-quality care. Objective: To assess the association of aggressive end-of-life care with bereaved family members' perceptions of the quality of end-of-life care and @entity1 ' goal attainment. Design, Setting, and @entity1 : Interviews with 1146 family members of Medicare @entity1 with advanced-stage lung or @entity14 in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) who died by the end of 2011 (median, 144.5 days after @entity204 ; interquartile range, 85.0-551.0 days). Exposures: Claims-based quality measures of aggressive end-of-life care (ie, intensive care unit [ICU] admission or repeated hospitalizations or emergency department visits during the last month of life; chemotherapy  <=2 weeks of @entity204 ; no hospice or  <=3 days of hospice services; and @entity204 occurring in the hospital). Main Outcomes and Measures: Family member-reported quality rating of "excellent" for end-of-life care. Secondary outcomes included @entity1 ' goal attainment (ie, end-of-life care congruent with @entity1 ' wishes and location of @entity204 occurred in preferred place). Results: Of 1146 @entity1 with @entity5 (median age, 76.0 years [interquartile range, 65.0-87.0 years]; 55.8% male), bereaved family members reported excellent end-of-life care for 51.3%. Family members reported excellent end-of-life care more often for @entity1 who received hospice care for longer than 3 days (58.8% [352/599]) than those who did not receive hospice care or received 3 or fewer days (43.1% [236/547]) (adjusted difference, 16.5 percentage points [95% CI, 10.7 to 22.4 percentage points]). In contrast, family members of @entity1 admitted to an ICU within 30 days of @entity204 reported excellent end-of-life care less often (45.0% [68/151]) than those who were not admitted to an ICU within 30 days of @entity204 (52.3% [520/995]) (adjusted difference, -9.4 percentage points [95% CI, -18.2 to -0.6 percentage points]). Similarly, family members of @entity1 who died in the hospital reported excellent end-of-life care less often (42.2% [194/460]) than those who did not die in the hospital (57.4% [394/686]) (adjusted difference, -17.0 percentage points [95% CI, -22.9 to -11.1 percentage points]). Family members of @entity1 who did not receive hospice care or received 3 or fewer days were less likely to report that @entity1 died in their preferred location (40.0% [152/380]) than those who received hospice care for longer than 3 days (72.8% [287/394]) (adjusted difference, -34.4 percentage points [95% CI, -41.7 to -27.0 percentage points]). Conclusions and Relevance: Among family members of older @entity1 with fee-for service Medicare who died of lung or @entity14 , earlier hospice enrollment, avoidance of ICU admissions within 30 days of @entity204 , and @entity204 occurring outside the hospital were associated with perceptions of better end-of-life care. These findings are supportive of advance care planning consistent with the preferences of @entity1 .

Family Perspectives on XXXX Care Near the End of Life.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'Participants'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death', 'deaths'] @entity5 :: ('MESH:D009369', 'Disease') :: ['advanced-stage cancer', 'cancer'] @entity14 :: ('MESH:D015179', 'Disease') :: ['colorectal cancer']
@entity5 :: (MESH:D009369,Disease) :: ['Aggressive Cancer']
