It seems counterintuitive and more than a little uncomfortable to be writing about end-of-life care during a time when millions are giving thanks for all they have in life. But it is that inability to talk about and realistically face death that often contributes to poor end-of-life care.

Data released last week from the Dartmouth Atlas Project is telling: one in three Medicare cancer patients spent at least part of their final month of life in the hospital or an intensive care unit. Six percent of these elderly cancer victims were still receiving chemotherapy two weeks before they died. In some parts of the country, more than 16 percent of these terminal patients were subjected to intensive procedures like endotracheal intubation, feeding tube placement or CPR.

Some may think this a tribute to the determination of these patients to fight until the end or at least a credit to the choices we have in our health care system. But, as the Dartmouth study notes, for frail, elderly patients, and any patient with advanced cancer, research has shown these treatments have limited or no benefit. In terms of quality of life, this is lack of compassion that can border on cruelty.

“The well-documented failure in counseling patients about their prognosis and the full range of care options, including early palliative care, leads many patients to acquiesce to more aggressive care without fully understanding its impact on the length and quality of life,” said David C. Goodman, M.D., lead author of the study. That failure also leads to billions of dollars in needless health care spending.

As for choice, there are better ones, like hospice. In Iowa, 69 percent of the patients in the Dartmouth study received hospice care, compared to about 50 percent in the nation overall. With more patients directed toward hospice, fewer die in the hospital – only about 25 percent in Iowa (compared to about 32 percent for the nation).

It is good news that Iowa is on the right track in terms of providing end-of-life care (in Mason City, only 7 percent of the study group died in the hospital, the lowest rate in the nation).  This is on par with other Dartmouth studies that show Iowa’s hospitals are much more consistent about providing the right care at the right time. But the studies also show there is notable variation within Iowa, just as there is across the nation and even among the country’s most renowned academic medical centers.

So, while Iowa can be grateful this Thanksgiving for having one of the best health care systems in the nation, there is room for improvement, including getting better at caring for patients who are close to death.  As Dartmouth researcher Elliott Fisher, M.D., concluded:

“These findings highlight important opportunities to improve the care of patients with serious, life-limiting illness. Patients and families must understand that they have choices – and that it is critical to have early discussions with their physicians about what most matters to them. Physicians and hospital leaders must also recognize that they have much to learn – and that serious inquiry into their current practices can help make sure that we are providing all the care that our patients want and need, but no more.”