Study Measures Time of Care for the Dying

Seventy minutes.

That’s the total amount of time you could expect to spend in the company of another human being each day if you were a hospital patient with a terminal illness.

So found researchers who placed hidden video cameras in the doorways of 59 seriously ill patients at Georgetown University Hospital, and clocked bedside contact to compare the care of patients with and without do-not-resuscitate orders. The study was published in the October issue of the American Journal of Medicine.

Average daily contact time broke down this way: Attending physicians, three minutes; interns and residents, nine minutes; nurses and nurses’ aides, 45 minutes. Most of this interaction occurred in two-and three-minute episodes spread over the course of the day; the only visits likely to last longer than five minutes, found researchers, were those from family. These totaled, on average, 13 minutes a day.

Contrary to anecdotal reports that patients with do-not-resuscitate orders are abandoned by the staff, the study found that such patients received slightly more attention than others. “The good news is that [terminal] patients don’t get any less time than others,” said lead researcher Daniel Sulmasy, chair of ethics at St. Vincent’s Manhattan Hospital and director of the Bioethics Institute of New York Medical College. “The bad news is that nobody gets [much] time.”

Sulmasy and colleagues also found that the amount of “visitor minutes” was associated with a patient’s race and diagnosis. Nonwhite patients received fewer visitor minutes than white patients, especially from family. Researchers said it was unclear whether social factors such as the difficulty of getting transportation to the hospital were to blame.

Patients with dementia received fewer visitor minutes; patients with malignant cancers received more. Other study subjects had AIDS, heart failure or obstructive lung disease.

In addressing what the study’s authors called “a major patient fear [of] abandonment at the end of life,” the study touched a nerve. In an editorial in the same journal, Paul Han and Robert Arnold of the University of Pittsburgh Medical Center argued that the study’s flaws, such as small sample size, limited its value. They also objected to implications that physicians should be spending more time with dying patients.

But they conceded that what the study showed about patients’ “sheer aloneness at the end of their lives points to something important and troubling about our culture and society.”