Serious Illness and End‐of‐Life Treatments for Nurses Compared with the General Population

Abstract

OBJECTIVES As key team members caring for people with advanced illness, nurses teach patients and families about managing their illnesses and help them to understand their options. Our objective was to determine if nurses' personal healthcare experience with serious illness and end‐of‐life (EOL) care differs from the general population as was shown for physicians. DESIGN Observational propensity‐matched cohort study. SETTING Fee‐for‐service Medicare. PARTICIPANTS Nurses' Health Study (NHS) and a random 20% national sample of Medicare beneficiaries aged 66 years or older with Alzheimer's disease and related dementias (ADRD) or congestive heart failure (CHF) diagnosed in the hospital. MEASUREMENTS Characteristics of care during the first year after diagnosis and the last 6 months of life (EOL). RESULTS Among 57 660 NHS participants, 7380 had ADRD and 5375 had CHF; 3227 ADRD patients and 2899 CHF patients subsequently died. Care patterns in the first year were similar for NHS participants and the matched national sample: hospitalization rates, emergency visits, and preventable hospitalizations were no different in either disease. Ambulatory visits were slightly higher for NHS participants than the national sample with ADRD (13.1 vs 12.5 visits; P < .01) and with CHF (13.7 vs 12.5; P < .001). Decedents in the NHS and national sample had similar acute care use (hospitalization and emergency visits) in both diseases, but those with ADRD were less likely to use life‐prolonging treatments such as mechanical ventilation (10.9% vs 13.5%; P = .001), less likely to die in a hospital with a stay in the intensive care unit (10.4% vs 12.1%; P = .03), and more likely to use hospice (58.9% vs 54.8%; P < .001). CHF at the EOL results were similar. CONCLUSIONS Nurses with newly identified serious illness experience similar care as the general Medicare population. However, at EOL, nurses are more likely to choose less aggressive treatments than the patients for whom they care. J Am Geriatr Soc 67:1582–1589, 2019

Culture and Sanity at the End of Life

“…In this issue, Bynum et al cleverly link the Nurses' Health Study (NHS), a cohort study with a population of over 120 000 female nurses with 42 years of followup, to the Medicare claims data to explore utilization patterns among people with Alzheimer dementia and related disorders (ADRDs) and heart failure (HF). 6 In sum, their findings were consistent with prior studies (ie, nurses and nonnurses use healthcare similarly).…”

“…Yet, the differences Bynum et al found between the nurse cohort and the nonnurse cohort for the outcomes of invasive interventions, death in the hospital, intensive care unit stay during terminal hospitalization, and hospice use only ranged from 2% to 4%. Unquestionably, the differences in end‐of‐life care patterns are statistically significant and clinically meaningful, but they are unremarkable.…”