End-of-Life Care Differs Between U.S., Canada, Study
WEDNESDAY, May 18 (HealthDay News) -- End-of-life care for older
people with advanced lung cancer differs in the United States and
in the Canadian province of Ontario, a new study says.
U.S. patients receive far more chemotherapy, while patients in
Ontario make much more use of hospital and emergency room services,
according to the analysis of data from the U.S. government and the
Ontario Cancer Registry. The information was collected from people
65 and older who died from non-small-cell lung cancer between 1999
Health-care services were used extensively by patients in both
countries, particularly in the last month of life. More than twice
as many people in Ontario died in a hospital (48.5 percent vs. 20.4
percent), even though most patients in Ontario have said they want
to die at home, the study reported.
Elderly people in both the United States and Canada receive
government-financed health care, but there are differences in
end-of-life coverage. In the United States, hospice care for
qualified patients is covered by Medicare. Ontario has no hospice
program comparable to what's available in the United States, but
the province provides palliative care through hospital acute-care
units, outpatient services and home health care.
According to the researchers, lack of hospice services in Canada
contributes to Ontario's higher rates of hospital and emergency
room visits and in-hospital deaths.
The findings, published online May 18 in the
Journal of the National Cancer Institute, could help show health planners and policy makers where changes in practices or programs could improve care for dying patients, the researchers said.
End-of-life care also varies from region to region in the United
States and Canada, Dr. David Goodman, of the Dartmouth Institute
for Health Policy and Clinical Practice, wrote in an accompanying
In addition, patient preferences vary from person to person, and
these preferences often go unheard, he said. The best type of
end-of-life care, Goodman said, involves the patient in the
The U.S. Agency for Healthcare Research and Quality outlines
advance planning for end-of-life care.
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