Comfort Care, Hospice, Code Status, and Goals of Care

Full Scope Human Longevity

Summary

What is your plan for medical care as you get older? Most people don’t know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more.

Morbidity and Mortality

Medical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks.

Story

In 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward.

Key Points

1. Comfort care is when the main goal of care is person’s quality of life

2. Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.

3. Code Status concerns a patient’s wishes when they are dead. It has nothing to do with their medical care while alive.

4. Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it.

References

- Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46.

- https://hospicefoundation.org/Hospice-Care/Hospice-Services

- Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.

- Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)

- Adair T

- Who dies where? Estimating the percentage of deaths that occur at home

- BMJ Global Health 2021

- QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020

- Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016

- Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”