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Wednesday, 18 October 2006 - 11:00 AM


R. Trafford Crump, M.P.A., Dartmouth Medical School, Hanover, NH and Hilary A. Llewellyn-Thomas, PhD, Dartmouth Medical School, Hanover, NH.

Purpose: Wide geographic variations in spending for Medicare beneficiaries in the last 6 months of life don't appear to reflect differences in either access to or quality of end-of-life (EOL) care. These variations are warranted if they reflect genuine variations in patients' informed preferences for elective EOL interventions. The study purpose was to determine whether there are within- or across-region differences in the preferences for EOL care reported by Medicare beneficiaries residing in regions with known variations in Medicare spending.

Methods: Medicare beneficiaries in 3 regions (Minneapolis MN, Rochester NY, Miami FL) were randomly selected from the sampling frame of a larger, national telephone survey that had addressed different research purposes. Participants were interviewed in person by trained Community Interviewers using a standardized interview schedule. Respondents considered 5 scenarios involving a choice between a relatively lower- or higher-intensity elective intervention in EOL care: A. own home vs. nursing home vs. hospital as care site; B. no drugs vs. life-prolonging drugs that lower quality of life; C. no drugs vs. quality-of-life enhancing drugs that reduce length of life; D. no respirator vs. respirator to extend life by 1 month; and E. no respirator vs. respirator to extend life by 1 week. For each scenario, participants categorically indicated if they'd prefer the relatively lower- or higher-intensity intervention.

Results: 585 Medicare beneficiaries were selected, 366 agreed to be contacted, and 179 participated in the in-person interview (participation rate among those contacted = 49%). Within each geographic region, the majority reported that they would choose: their own home for EOL care (80%) ; no life-prolonging drugs that lower quality of life (91%); and no respirator to extend life by either 1 month (84%) or 1 week (88%). However, the majority reported that they would choose quality-of-life enhancing drugs that reduce length of life (77%). Chi-square tests detected no significant across-region differences in the distributions of these preferences.

Conclusions: The majority of Medicare beneficiaries may prefer lower-intensity EOL interventions, whether they reside in regions with lower (Minneapolis MN, Rochester NY) or higher (Miami FL) spending for EOL care. This, in turn, implies that at least in regions with higher Medicare spending beneficiaries may not actually be getting the care they want in their last 6 months of life.

See more of Concurrent Abstracts L: Disparities and Health Services Research
See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)