This piece was first published in Reuters Health. LMM President Randi Belisomo is a contributor.

Most doctors would not want high-intensity treatment near the end of life, according to a new study from Stanford University School of Medicine.

In 2013, researchers surveyed nearly 1,100 young doctors who were finishing their training in a variety of medical specialties. Nearly nine in 10 said they would choose a do-not-resuscitate status near the end of life.

“We see too much in our practice and training when high-intensity treatments actually hurt patients,” says Vyjeyanthi Periyakoil, a geriatrician who led the study.

She says she isn’t surprised most physicians opt to die gently, as they recognize “tipping points” when treatments become ineffective. “We know when terminally ill, treatments only help prolong the dying process, and there is no return on your investment,” she told Reuters Health.

Still, she and her coauthors say, what doctors want for themselves and what they provide for patients is often at odds.

“More than 80 percent of patients say that they wish to avoid hospitalizations and high intensity care at the end-of-life, but their wishes are often overridden,” the researchers write in the open-access journal PLOS One.

The gap “is not likely due to patient and family choice,” the authors contend. Instead, they say, it’s largely due to things like hospital size and doctors’ practice style.

When the researchers compared their 2013 survey findings to a survey done more than 20 years earlier, they found that overall, doctors’ opinions hadn’t changed much over time.

The earlier survey was given to 790 community doctors in Arkansas in 1989, one year before Congress passed the Patient Self-Determination Act to require that health institutions ask patients if they have advance directives.

The 1989 and 2013 groups had different opinions in only three out of 14 areas. First, the modern doctors were more likely to say they have greater confidence in their treatment decisions if they’re guided by a patient’s advance directive. They were also less worried about legal consequences of limiting treatment when following an advance directive.

Finally, the modern group was less likely to believe that widespread acceptance of advance directives would result in less aggressive treatment even for people who didn’t prepare such a directive.

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