Prevalence and cost of futile interventions for common comorbidities in terminally-ill cancer and cardiac patients in British Columbia

Project number: 
15-171
Approval date: 
Tuesday, January 19, 2016
Principal Investigator: 
Sam,Davis
Institution: 
University of British Columbia (UBC)
Funding Agency: 
Not Available
Datasets requested: 
bc cancer
Home and Community Care (BC Ministry of Health)
Consolidation file (BC Ministry of Health)
bc cancer-external
Mental Health (BC Ministry of Health)
Medical Services Plan (BC Ministry of Health)
PharmaNet
Deaths (BC Vital Statistics Agency)
Hospital Separations (BC Ministry of Health)
Research objective: 

This project will provide a unique opportunity to: 1) describe current palliative care practices; 2) examine use of futile interventions for common comorbidities in terminally-ill patients; and 3) identify deficiencies, if any, in the management of terminally-ill patients. We hope that by determining the degree to which futile interventions in end-of-life patients may be excessive, we may be better able to inform health administrators and providers, end-of-life patients and their families, and the general public about appropriate end-of-life care. With this increased clarity, we can help to develop interventions that empower both patients and physicians to specifically address some of these deficient areas and ultimately improve future care for terminally-ill patients.

Aim 1: To characterize the prevalence and cost of futile care among terminally-ill cancer patients.
i. To measure the receipt of futile interventions, including cardiovascular medications (statins, antihypertensives, antiplatelets, and anticoagulants), diabetic medications (hypoglycemics), other medications (gastric protectors, other preventative medications), duplicate medications, vaccinations, cholesterol testing, bone densitometry, screening for cancers, and other diagnostic and screening services (e.g. endoscopy, CT scans) in terminally-ill cancer patients
Hypothesis (i): Terminally-ill cancer patients are highly likely to receive interventions that are considered futile, even after adjusting for various clinical factors.

ii. To evaluate the cost associated with the use of futile interventions in terminally-ill cancer patients.
Hypothesis (ii): Use of futile care in terminally-ill cancer patients will represent a significant, modifiable cost to the health care system.

iii. To identify patient, provider, disease, treatment, and temporal factors that may influence the receipt of futile care in terminally-ill cancer patients.
Hypothesis (iii): Patient-related factors, such as age, comorbidities, cause of terminal illness, and mental status, as well as physician-related factors, such as type of specialty and practice, are associated with the receipt of futile care among terminally-ill cancer patients.

Aim 2: To characterize the prevalence and cost of futile care among terminally-ill cardiac patients.
i. To measure the receipt of futile interventions, including cardiovascular medications (statins, antihypertensives, antiplatelets, and anticoagulants), diabetic medications (hypoglycemics), other medications (gastric protectors, other preventative medications), duplicate medications, vaccinations, cholesterol testing, bone densitometry, screening for cancers, and other diagnostic and screening services (e.g. endoscopy, CT scans) in terminally-ill cardiac patients.
Hypothesis (i): Terminally-ill cardiac patients are highly likely to receive interventions that are considered futile, even after adjusting for various clinical factors.

ii. To evaluate the cost associated with the use of futile interventions in terminally-ill cardiac patients.
Hypothesis (ii): Use of futile care in terminally-ill cardiac patients will represent a significant, modifiable cost to the health care system.

iii. To identify patient, provider, disease, treatment, and temporal factors that may influence the receipt of futile care in terminally-ill cardiac patients.
Hypothesis (iii): Patient-related factors, such as age, comorbidities, cause of terminal illness, and mental status, as well as physician-related factors, such as type of specialty and practice, are associated with the receipt of futile care among terminally-ill cardiac patients.

Aim 3: To compare the prevalence and cost of futile care among terminally-ill cancer patients and terminally-ill cardiac patients.
Hypothesis: The use and cost of futile interventions in terminally-ill cancer patients will be greater than that in terminally-ill cardiac patients since some interventions, such as statins and antihypertensives, may be considered futile in end-of-life cancer patients, but may represent essential care in end-of-life cardiac patients.


Page last revised: December 5, 2017