Number and Necessity of Tests Performed In the Last Week of Life of a Cancer Patient

Introduction: During the last few months of life patients often suffer from significant psychological and physical distress. Studies in the past have found that the amount of tests conducted on a patient tends to increase as death approaches. In many cases the tests performed on a patient in the last few months of life were unnecessary, causing needless discomfort. This study focuses on the number and necessity of tests conducted in the last week of life of a terminal cancer patient. Methods: This study was conducted at Liverpool Hospital, a university teaching hospital located in New South Wales, Australia. Data from deceased cancer patients referred to palliative care for consultation was collected retrospectively from electronic medical records and patient clinical notes. A standard data extraction form was developed to collect patient characteristics, tests ordered, patient progress and symptoms over a period of 7 days up until death. Two palliative care specialists not involved with care of these patients then independently evaluated the need and outcome of each test. These specialists were aware that the patients had all died. Results: 33 patients were included in the study over a period of 3 months. A total number of 1051 tests were conducted over a combined total of 231 in-hospital days. The average number of tests conducted during the last 7 days prior to death per patient was 31.85. On average 65.16% of tests conducted were assessed as unnecessary, 28.80% neutral and 6.04% necessary per patient. The most frequent test category ordered was blood chemistry (41.19%) followed by complete blood count (28.83%) and coagulation (10.47%) tests. In total, combined over all 33 patients, 69.27% of the tests were deemed unnecessary, 25.21% neutral and 5.52% necessary Conclusion: End of life cancer patients are subjected to frequent and often unnecessary tests and investigations. Much improvement can be made in hospital systems and clinician education in order to increase the quality of patient care. Our study prompts clinicians to evaluate the necessity and benefit of diagnostic tests conducted on end of life cancer patients before performing them and provides recommendations for improvement.