End of Life and Palliative Care
End of Life Care
End of life care is a critically important area for research and clinical quality improvement. Dr. Russell Phillips 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, Roger Davis, Ellen McCarthy 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. Mara Schonberg 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.