Providing incentives to physicians to record end-of-life wishes of their patients into their medical records greatly boosted the practice, Reuters reported. The practice could significantly reduce the costs of providing care if widely adopted.
Researchers at the University of California at San Francisco (UCSF) paid medical residents $400 if they engaged in a group effort to record end-of-life wishes for their patients in their medical records. As a result, the proportion of patients with end-of-life information in their records rose from 22 percent to 90 percent. The findings were published in the most recent issue of JAMA Internal Medicine.
Many patients and physicians are reluctant to bring up end-of-life issues. As a result, end-of-life care is one of the biggest drivers of healthcare delivery costs in the U.S. About 28 percent of all Medicare expenditures are tied to care provided in the last six months of life, and many hospitals will continue to resuscitate a dying patient if there is no living will or explicit record of what the person wished to do in such a situation.
And despite the success of the UCSF study, at least one well-respected clinician--Mary Tinetti, M.D., chief of geriatrics at the Yale School of Medicine--was discomfited by the notion of paying doctors to gather such data, according to Reuters.
But Tinetti told the wire service that "I think the positive thing about this is how successful they were in going from so low a number to such a high number of patients who expressed their wishes and had those wishes transmitted."