What Is the “Right” Intensity of Care at the End of Life and How Do We Get There?
Authors: J. Randall Curtis, Ruth A. Engelberg
Journal: Annals of Internal Medicine (2011)

Editorials15 February 2011What Is the “Right” Intensity of Care at the End of Life and How Do We Get There?J. Randall Curtis, MD, MPH and Ruth A. Engelberg, PhDJ. Randall Curtis, MD, MPHFrom Harborview Medical Center, University of Washington, Seattle, WA 98104Search for more papers by this author and Ruth A. Engelberg, PhDFrom Harborview Medical Center, University of Washington, Seattle, WA 98104Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-4-201102150-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What is the “right” intensity of care at the end of life? The answer to this question is simple: It depends. However, the interesting and important follow-up questions are what does it depend on and what should it depend on? In this issue, Kelley and colleagues (1) report results of a study that add to our understanding of the determinants of intensity of care at the end of life. This study, and others before it, demonstrates that the intensity of end-of-life care depends on geographic region and is associated with regional characteristics, including number of hospital beds per capita and ...References1. Kelley AS, Ettner SL, Morrison RS, Du Q, Wenger NS, Sarkisian CA. Determinants of medical expenditures in the last 6 months of life. Ann Intern Med. 2011;154:235-42. LinkGoogle Scholar2. Barnato AE, Berhane Z, Weissfeld LA, Chang CC, Linde-Zwirble WT, Angus DC; Robert Wood Johnson Foundation ICU End-of-Life Peer Group. Racial variation in end-of-life intensive care use: a race or hospital effect? Health Serv Res. 2006;41:2219-37. [PMID: 17116117] CrossrefMedlineGoogle Scholar3. Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK. 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Thornton JD, Pham K, Engelberg RA, Jackson JC, Curtis JR. Families with limited English proficiency receive less information and support in interpreted intensive care unit family conferences. Crit Care Med. 2009;37:89-95. [PMID: 19050633] CrossrefMedlineGoogle Scholar8. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345. [PMID: 20332506] CrossrefMedlineGoogle Scholar9. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362:1211-8. [PMID: 20357283] CrossrefMedlineGoogle Scholar10. Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Soc. 2007;55:189-94. [PMID: 17302654] CrossrefMedlineGoogle Scholar11. Norris K, Merriman MP, Curtis JR, Asp C, Tuholske L, Byock IR. 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[PMID: 16791111] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: J. Randall Curtis, MD, MPH; Ruth A. Engelberg, PhDAffiliations: From Harborview Medical Center, University of Washington, Seattle, WA 98104Grant Support: By the National Institute of Nursing Research grants R01 NR005226 and R01 NR009987 and the National Heart, Lung, and Blood Institute grant K24 HL68593 (Drs. Curtis and Engelberg).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2909.Corresponding Author: J. Randall Curtis, MD, MPH, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, University of Washington, 325 Ninth Avenue, Seattle, WA 98104-2499; e-mail, jrc@u.washington.edu.Current Author Addresses: Dr. Curtis: Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, University of Washington, 325 Ninth Avenue, Seattle, WA 98104-2499.Dr. Engelberg: Division of Pulmonary and Critical Care, University of Washington, Box 359765, 325 Ninth Avenue, Seattle, WA 98104-2499. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDeterminants of Medical Expenditures in the Last 6 Months of Life Amy S. Kelley , Susan L. Ettner , R. Sean Morrison , Qingling Du , Neil S. Wenger , and Catherine A. Sarkisian Metrics Cited byWhat are the ethical conflicts faced by Mexican internists?Attitudes of older adults with serious competing health risks toward their implantable cardioverter-defibrillators: a pilot studyGeographic Variation in Black–White Differences in End-of-Life Care for Patients with ESRDNighttime Intensivist Physician Staffing in the ICUBegriffsklärungenDeveloping a Harvesting Plan: Optimising Retirement Spending in the Face of Economic, Social and Personal Risk 15 February 2011Volume 154, Issue 4Page: 283-284KeywordsCaregiversCommunication in health careCritical careEnd of life careLungsPatient advocacyPatientsQuality of lifeRacial and ethnic issuesResearch grants ePublished: 15 February 2011 Issue Published: 15 February 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...