The End–of-Life Experience for International Patients: Review from a Destination Medical Center (S763)

Abstract

•Recognize the unique nature of the population of seriously ill international patients.•Review the end-of-life experience of seriously ill international patients at a major US referral center. Patients from all over the world travel to the United States to receive medical care. Seriously ill international patients and their families may face barriers to goal concordant end-of-life (EOL) care, especially those whose illness severity prevents a return to their home country. Little is known about the EOL experiences of this diverse group. This review was designed to characterize the EOL experiences of all international patients that died at Mayo Clinic Rochester, a tertiary care academic medical center with a large international referral base, from 2005-2015. After institutional review board approval, charts in the electronic medical record were reviewed for patients that died from 01/01/2005-12/31/2015 with a primary address outside of the United States. Data were abstracted and analyzed with standard statistical methods. Eighty-two (n = 82) international patients meeting the inclusion criteria died at Mayo Clinic between 2005-2015 with a median age at death of 59.5 years (range 21-88). Forty-eight patients (59%) were male, and the top three countries of origin were Saudi Arabia (n = 20), Kuwait (n = 16), and Canada (n = 9). The median length of the terminal hospital stay was 13 days (range 1-231 days). Nine patients (11%) had completed an advanced directive and 74% of patients had a DNR status at time of death. Thirty-four patients (42%) received palliative medicine consultation during terminal admission at a median of 8.5 days before death. Most changes to resuscitation preferences occurred during terminal hospitalization; three patients (4%) had do not resuscitate (DNR) status on admission and 61 patients (74%) were DNR at time of death. Compared to other published datasets of American patients, our cohort demonstrated a much lower completion of advance directives (11%).