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October 16, 1996

Care and Cost Savings at the End of Life

Author Affiliations

for the SUPPORT Investigators; The George Washington University Medical Center Washington, DC

JAMA. 1996;276(15):1217. doi:10.1001/jama.1996.03540150019013

To the Editor.  —Dr Emanuel's1 characterization of the methods and findings of SUPPORT (The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) might mislead the reader as to the relevance of SUPPORT for understanding costs at the end of life.2-5 To date, SUPPORT publications on costs have been descriptive of overall costs not related to advance directives or to the end of life. The SUPPORT manuscripts that address the association of advance directives and costs are either in preparation or under review, and it would be premature to comment on these now.Emanuel describes the SUPPORT intervention as "indirect and flawed." The intervention included providing multiple prognostic estimates and reports of patient and family interviews to the physicians and medical records, and providing a specially trained and dedicated nurse to encourage improved information and communication among patient, family, physicians, and care team.3 The approach was polite,