The SUPPORT Study
Although in the case study , Harriet Billings wanted to continue to receive life-sustaining therapy, in many instances patients wish to discontinue interventions. Unfortunately, even with the increased attention to end-of-life issues in lay and medical publication, physicians are often unaware of their patients’ preferences concerning end-of-life care. The study to understand prognoses and preferences for outcomes and risks of treatment and its companion study the hospitalized elderly longitudinal project, which are both studies of seriously ill hospitalized patients, documented the lack of communication between physicians and their very ill patients about end-of-life issues.
However, most importantly, the SUPPORT study suggested that since physicians did not understand their patients’ preferences about end-of-life care, they often continued aggressive , painful life-sustaining treatment beyond the time patients and their families believed was appropriate. Because of that, families indicated that patients spent a considerable amount of time during their last days and hours in pain. One of the reasons offered for such aggressive care at the end of life in the SUPPORT study was not clear to the healthcare providers that patients were definitely dying until less than 48 hours before the patients’ deaths. How then should a healthcare provider know when to counsel palliative care? How should a provider know when care was excessive for a patient?