Most doctors would reject aggressive treatments if they were terminally ill, a study has found.
They would opt for a “do-not-resuscitate” approach, should they find themselves on the receiving end of medical treatment.
Yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, Stanford University School of Medicine found.
Studies also found that many patients would prefer to die at home without life-prolonging interventions – but are often ignored.
The study, published in the journal PLOS ONE, found 88.3 per cent of doctors would choose do-not-resuscitate orders for themselves and argued the reason between this disparity and how patients were treated needed to be better understood.
Clinical associate professor of medicine Dr VJ Periyakoil said: “Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn’t choose it for ourselves? The reasons likely are multifaceted and complex.”
As a geriatrics doctor, she understood the disconnect between the care doctors wanted for themselves at the end of life and what they did for their patients. She argued it was not down to doctors trying to make more money or because they were intentionally insensitive to their patients’ desires.
At the core of the problem was a “biomedical system” that rewarded doctors for taking action, and not for talking to their patients.
She said: “Our current default is ‘doing’, but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself.
“It’s tricky, but physicians don’t have to figure it out by themselves. They can talk to the patients and their families and to the other interdisciplinary team members, and it becomes much easier.”
Dr Periyakoil added: “But we don’t train doctors to talk, or reward them for talking. We train them to do and reward them for doing. The system needs to be changed.”
The study examined changing doctors’ attitudes to a new law designed to give patients more control over determining end-of-life care decisions.
“Advance directives” are documents that patients can use to indicate end-of-life care preferences.
The study involved 1,081 doctors who, in 2013, completed a web-based advanced directive form and a 14-item advance directive attitude survey at Stanford Hospital and Clinics and the Veterans Affairs Palo Alto Health Care System.
It also involved 790 doctors from Arkansas who were asked the same 14 survey questions – but did not complete an advance directive form – in a 1989 study published in the Journal of the American Medical Association.
Surprisingly, results showed that doctors’ attitudes toward advance directives had changed little in 25 years.
The lack of change in doctors’ attitudes toward advance directives mirrored what the study described as the medical system’s continued focus on aggressive treatment at the end of life, despite the fact that most Americans now say they would prefer to die at home without life-prolonging interventions.