Editing Terminal illness (section)

== Medical care ==
Many aspects of medical care are different for terminal patients compared to patients in the hospital for other reasons.

=== Doctor–patient relationships ===
[[Doctor–patient relationships]] are crucial in any medical setting, and especially so for terminal patients. There must be an inherent trust in the doctor to provide the best possible care for the patient. In the case of terminal illness, there is often ambiguity in communication with the patient about their condition. While terminal condition prognosis is often a grave matter, doctors do not wish to quash all hope, for it could unnecessarily harm the patient's mental state and have [[unintended consequences]]. However, being overly optimistic about outcomes can leave patients and families devastated when negative results arise, as is often the case with terminal illness.<ref name="Chen-2017"/>

=== Mortality predictions ===
Often, a patient is considered terminally ill when his or her estimated life expectancy is six months or less, under the assumption that the disease will run its normal course based on previous data from other patients. The six-month standard is arbitrary, and best available estimates of longevity may be incorrect. Though a given patient may properly be considered terminal, this is not a guarantee that the patient will die within six months.  Similarly, a patient with a slowly progressing disease, such as [[AIDS]], may not be considered terminally ill if the best estimate of longevity is greater than six months. However, this does not guarantee that the patient will not die unexpectedly early.<ref name="titleTerminal Illness2">{{cite web|url=http://www.ascensionhealth.org/ethics/public/issues/terminal.asp|title=Terminal Illness|archive-url=https://web.archive.org/web/20071013074453/http://www.ascensionhealth.org/ethics/public/issues/terminal.asp|archive-date=2007-10-13}}</ref>

In general, physicians slightly overestimate the survival time of terminally ill cancer patients, so that, for example, a person who is expected to live for about six weeks would likely die around four weeks.<ref name="pmid12881260">{{cite journal|author=Glare P|author2=Virik K|author3=Jones M|last4=Hudson|first4=M|last5=Eychmuller|first5=S|last6=Simes|first6=J|last7=Christakis|first7=N|display-authors=3|year=2003|title=A systematic review of physicians' survival predictions in terminally ill cancer patients|journal=[[BMJ]]|volume=327|issue=7408|pages=195–8|doi=10.1136/bmj.327.7408.195|pmc=166124|pmid=12881260|name-list-style=vanc}}</ref>

A recent systematic review on palliative patients in general, rather than specifically cancer patients, states the following: "Accuracy of categorical estimates in this systematic review ranged from 23% up to 78% and continuous estimates over-predicted actual survival by, potentially, a factor of two." There was no evidence that any specific type of clinician was better at making these predictions.<ref name="White-2016">{{Cite journal|last1=White|first1=Nicola|last2=Reid|first2=Fiona|last3=Harris|first3=Adam|last4=Harries|first4=Priscilla|last5=Stone|first5=Patrick|date=2016-08-25|title=A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts?|journal=PLOS ONE|volume=11|issue=8|pages=e0161407|doi=10.1371/journal.pone.0161407|pmid=27560380|pmc=4999179|issn=1932-6203|bibcode=2016PLoSO..1161407W|doi-access=free}}</ref>

=== Healthcare spending ===
Healthcare during the last year of life is costly, especially for patients who used hospital services often during end-of-life.<ref>{{Cite journal|last1=Riley|first1=Gerald F|last2=Lubitz|first2=James D|year=2010|title=Long-Term Trends in Medicare Payments in the Last Year of Life|journal=Health Services Research|volume=45|issue=2|pages=565–576|doi=10.1111/j.1475-6773.2010.01082.x|issn=0017-9124|pmc=2838161|pmid=20148984}}</ref>

In fact, according to Langton et al., there were "exponential increases in service use and costs as death approached."<ref>{{Cite journal|last1=Langton|first1=Julia M|last2=Blanch|first2=Bianca|last3=Drew|first3=Anna K|last4=Haas|first4=Marion|last5=Ingham|first5=Jane M|last6=Pearson|first6=Sallie-Anne|title=Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: A systematic review|journal=Palliative Medicine|volume=28|issue=10|pages=1167–1196|doi=10.1177/0269216314533813|pmid=24866758|year=2014|s2cid=42436569}}</ref>

Many dying terminal patients are also brought to the [[emergency department]] (ED) at the end of life when treatment is no longer beneficial, raising costs and using limited space in the ED.<ref name="Forero-2012">{{Cite journal|last1=Forero|first1=Roberto|last2=McDonnell|first2=Geoff|last3=Gallego|first3=Blanca|last4=McCarthy|first4=Sally|last5=Mohsin|first5=Mohammed|last6=Shanley|first6=Chris|last7=Formby|first7=Frank|last8=Hillman|first8=Ken|year=2012|title=A Literature Review on Care at the End-of-Life in the Emergency Department|journal=Emergency Medicine International|volume=2012|pages=486516|doi=10.1155/2012/486516|issn=2090-2840|pmc=3303563|pmid=22500239|doi-access=free}}</ref>

While there are often claims about "disproportionate" spending of money and resources on end-of-life patients, data have not proven this type of correlation.<ref>{{Cite journal|last=Scitovsky|first=Anne A|year=2005|title="The High Cost of Dying": What Do the Data Show?|journal=The Milbank Quarterly|volume=83|issue=4|pages=825–841|doi=10.1111/j.1468-0009.2005.00402.x|issn=0887-378X|pmc=2690284|pmid=16279969}}</ref>

The cost of healthcare for end-of-life patients is 13% of annual healthcare spending in the U.S. However, of the group of patients with the highest healthcare spending, end-of-life patients only made up 11% of these people, meaning the most expensive spending is not made up mostly of terminal patients.<ref>{{Cite journal|last1=Aldridge|first1=Melissa D.|last2=Kelley|first2=Amy S.|year=2015|title=The Myth Regarding the High Cost of End-of-Life Care|journal=American Journal of Public Health|volume=105|issue=12|pages=2411–2415|doi=10.2105/AJPH.2015.302889|issn=0090-0036|pmc=4638261|pmid=26469646}}</ref>

Many recent studies have shown that [[palliative care]] and [[hospice]] options as an alternative are much less expensive for end-of-life patients.<ref name="Chiang-2015a"/><ref name="Chiang-2015b"/><ref name="Smith-2014"/>