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Special Communication |

Resurrecting Treatment Histories of Dead Patients:  A Study Design That Should Be Laid to Rest

Peter B. Bach, MD, MAPP; Deborah Schrag, MD, MPH; Colin B. Begg, PhD
JAMA. 2004;292(22):2765-2770. doi:10.1001/jama.292.22.2765.
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In this article we address whether studies of care rendered to patients prior to their death (“studies of decedents”) produce an accurate portrait of care provided to patients who are dying. Studies of decedents typically analyze the care provided to patients over a defined interval antecedent to death. Studies of dying patients analyze care provided to patients subsequent to the time that their terminal status is perceived. We address whether 2 fundamental differences between studies of decedents and studies of the dying—the ways that subjects are identified and the time periods that are examined—lead to differences in interpretation of study results. Using examples from population-based cohorts of individuals with cancer, we show that both the differences in subject selection and time period introduce very substantial biases into studies of decedents. We conclude that studying care received prior to death can lead to invalid conclusions about the quality or type of care provided to dying patients.

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Figure 1. Distribution of Survival Times for Individuals Aged 65 Years and Older Diagnosed With Stage IIIB Non–Small-Cell Lung Cancer Between 1992 and 1999 (n=13 050)
Graphic Jump Location

Data are from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program.

Figure 2. Estimated Cumulative Expenditures Over the Last Year of Life for “Typical” Medicare Beneficiaries Diagnosed With Stage IV Colon Cancer Between 1992 and 1999
Graphic Jump Location

The x-axis reflects the number of months prior to death. Data are from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program linked to Medicare claims.

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