New research has found that 95.5 percent of individuals who died with a coronavirus-positive diagnosis in the Mass General Brigham health system did so in the hospital, according to a letter published in the Journal of Palliative Medicine.
The data, collected between February 18 and May 18, also revealed that about 40 percent of hospital deaths occurred in the intensive care unit, further highlighting the need for more ICU beds amid the surge of virus cases across the country.
Based on the overwhelming number of patients who died in the hospital and ICU, the research noted that it is highly likely that most patients who expressed a desire to die at home weren’t able to do so.
“Surveys have shown that most patients prefer to die at home, but there is also an ongoing debate about whether that is the best option for patients when resources for at-home care are limited,” corresponding author Dr. Isaac Chua, of the Division of General Internal Medicine and Primary Care at Mass General Brigham, said in a news release.
“The purpose of this study was to open up a larger conversation about whether we need to provide more advanced care at home, so that if patients want to die at home, they would have that option.”
The findings were released as the United States has already witnessed sixteen million coronavirus infections and more than three hundred thousand confirmed deaths, according to the latest data from Johns Hopkins University.
The study only included sixteen patients who died outside the hospital, which made observations about this particular group difficult to generalize. However, two important patterns eventually emerged.
First, 93 percent of the patients who died outside the hospital were White, whereas White patients accounted for only about 61 percent of those who died in the hospital. Second, the population who died outside the hospital had a median age of 91.2, compared to 77.8 among those who died inside the hospital.
Chua hypothesized that older adults may have been more prepared to make end-of-life decisions outside the hospital, while younger patients may have been more likely to continue to pursue hospital-based care.
“Most COVID-19 patients likely have not been thinking about their own mortality, and so they may be undecided about what they want,” he said. “There’s a lot of uncertainty and a lot of stress.”
Doctors and hospital staff likely faced plenty of uncertainty as well.
“Especially at the beginning of the pandemic, the prognostic factors for good and bad outcomes were unknown. It’s hard to create a pathway for sound end-of-life care because of how novel this virus is, how little we know about it, and how hard it is to plan ahead,” Chua said.
“Our health-care system needs to be thoughtful about different patient trajectories, and patients should really think through what they would want, too. Even if one isn’t anticipating a poor outcome, being able to have these difficult conversations early on in a hospitalization enables the hospital team to figure out what it can do to plan ahead and be as patient-centered as possible, coordinating resources to align care with patient priorities.”
Ethen Kim Lieser is a Minneapolis-based Science and Tech Editor who has held posts at Google, The Korea Herald, Lincoln Journal Star, AsianWeek, and Arirang TV. Follow or contact him on LinkedIn.