"The ICU is a rescue center, and I don't think you should send anyone there unless you have some hope that you can rescue them, and you can not rescue people with metastatic cancer" at this late stage.
"In an ideal setting, people would get the care they want, and we would figure out a process to assess preferences and deliver preference-sensitive care in all settings," she says. "It wouldn't be the patient's burden to figure out where they're going to get what they need."
The report follows the Dartmouth Atlas Project's voluminous report from 2010, which first pointed to wide regional disparity among the nation's hospitals in aggressiveness of care during a terminal cancer patient's last few weeks of life.
Medicare Fee-for-Service Model to Blame?
Morden noted that the Medicare fee-for-service payment system may be behind much of the trend for more aggressive end-of-life care. "I don't necessarily think that on average, at an institution that has tendencies toward more aggressive intense care, that there are individual physicians running around with this in mind, specifically. But the incentives, consciously or subconsciously, all push people to do more because we get paid for what we do."
Oncologists, she says, make "the overwhelming majority of their income from chemotherapy as opposed to sitting with patients and consulting, giving advice about treatment decisions."