"For example, while patients cared for by New York University's Langone Medical Center who died in 2007 spent a relatively high number of days in the hospital in the last six months of life, NYU led academic medical centers with a 29% decrease (26.9 to 19.1 days) by 2010," the report says.
"Some hospitals with a relatively low number of hospital days reduced them even further," for example, at Fletcher Allen Health Care, hospital days for dying patients "fell about 22%, from 11 to 8.6 days."
Goodman puts some blame for high intensity of end-of-life care on clinicians who "are not very good at assessing patient preferences. We don't receive the training to do it. It's not enough for physicians to be well-meaning, and not sufficient for physicians to assume that everyone wants to live one more day."
Doctors need to "provide accurate information about uncertainty, choices and possible outcomes" of aggressive care… and what treatment entails," and that making good on a pledge to extend life a week or a month longer, saying "there's hope for you," may mean the patient will spend most of that time in the hospital.
"Too often those discussions never occur, and when they do, physicians paint an overly optimistic scenario of patients' chances. It's rare that a patient would be seeking those additional days if they knew they would all be spent on a ventilator in an ICU."