End of Life Care
End of life care is a critically important area for research and clinical
quality improvement. Dr.
directed Beth Israel Deaconess Medical Center's participation in the
SUPPORT project that followed more than 9100 seriously ill patients. He has
published important findings about end of life care, joined by Drs.
Mary Beth Hamel,
and many of the Division's fellows. These analyses have included developing
and validating prognostic models for patients in coma, assessing the impact
of advanced directives, identifying determinants of resource use,
describing patients' experiences as death approaches, and examining the
effect of subspecialty care on patient outcomes and costs.
Dr. Hamel has led analyses of the effect of age on clinical decision
making, as well as the cost-effectiveness of life-extending treatments such
as dialysis and ventilator support for seriously ill patients. Drs.
Phillips and Hamel were lead editors of a supplement to the Journal of the
American Geriatric Society that presented new data from SUPPORT as well as
perspective and review articles. The supplement also included a series of
articles that described patients' experience as death approached in terms
of symptoms, quality of life, and preferences for care. Dr. Hamel is now
extending this work by studying decision-making and outcomes of major
surgery in elderly patients.
Dr. McCarthy, an epidemiologist focusing on cancer related health services
research, is studying use of hospice near the end of life for patients with
cancer. She has examined the effect of health insurance on hospice care and
a study of hospitalization among hospice patients. Dr. McCarthy is
additionally working with Dr.
on breast cancer screening in women 80 years of age or older. She has also
collaborated with Dr. Phillips on analyses of SUPPORT data examining
symptoms and preferences as death approaches for patients with lung or
colon cancer, and for patients with congestive heart failure.
directs an ethics support service to assist physicians caring for complex
patients. He developed a palliative care option for patients near the end
of life, with support from the Soros Foundation, as a Project on Death in
America Scholar. Dr.
worked with him to evaluate the effect of the palliative care program on
patients' experiences, quality of care, and clinical decision-making, and
has also mentored fellows on a number of projects, including a study of use
of breast-conserving treatment in Asian-American women with Dr. Mita Goel.
Palliative Care Program