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Medical Rounds

Aggressive Treatment Persists

While more people appear to be designating power of attorney privileges to a loved one, a new study has found no corresponding impact on their rates of aggressive medical care received in the last weeks of life.

In a review of nearly 2,000 surveys with people whose loved ones died of cancer, a team led by Johns Hopkins researchers found a 40 percent increase over a 12-year period in the number of patients with cancer who participated in designating durable power of attorney privileges to a loved one. But nearly 40 percent of the survey respondents also said their loved ones did not discuss end-of-life care preferences with them. Results of the survey review were published online July 9 in JAMA Oncology.

“Although more cancer patients are assigning power of attorney privileges to someone they know and trust to make their medical decisions when they can’t, this practice may be the least helpful among advance care planning tactics because it may be least associated with treatment intensity at the end of life,” says Amol Narang, a study author and Johns Hopkins resident in radiation oncology and molecular radiation sciences.

The researchers also reviewed survey responses for information on whether patients who were terminally ill with cancer died in the hospital, had certain treatments—such as chemotherapy—limited or withheld in the last two weeks of life, or whether they received “all care possible” at the end of life. Survey results showed no changes in hospital-based deaths or treatment limitations during the study period, although the number of patients who received “all care possible” at the end of life increased from 7 percent in 2000 to 58 percent in 2012.

Patients who created living wills or had end-of-life discussions were twice as likely to limit or withhold certain treatments at the end of life, the researchers found. And although granting power of attorney did decrease the odds of terminally ill patients dying in the hospital as opposed to hospice or their home, it was not associated with treatment limitations.