Dying in America: Healthcare leaders must bolster end-of-life care discussions, efforts

Healthcare leaders and providers must become comfortable talking about end-of-life care and death with patients, as the discussion is more important now than ever before, according to a new report from the Institute of Medicine (IOM).

The report, "Dying in America," found that the demand for family caregivers is on the rise, especially because end-of-life care is fragmented and can lead to preventable hospitalizations. Research also found that although palliative care is associated with higher quality of life, wide-spread referral to palliative care is slow.  

"The bottom line is the healthcare system is poorly designed to meet the needs of patients near the end of life," David M. Walker, a former United States comptroller general and chairman of the 21-person panel that released the report, told the New York Times. "The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly."

Most people nearing end-of-life care aren't capable of making the decision on their own, thus advance planning is essential, and hospitals must honor those wishes, the report states. Young, poor, minority and less-educated patients are less likely to have these kinds of conversations with their clinicians, so doctors must take the initiative to begin these discussions. Incentivizing such dialogue would encourage doctors to broach the subject, the report said.

Associations, institutions and organizations must establish appropriate training and certification when it comes to end-of-life care credentials, and all clinicians must be at least competent in basic palliative care information.

The report comes after a time when discussions about end-of-life care were mired in political mudslinging. "A rational and responsible national conversation about preparing for death and end-of-life care has been virtually impossible over the past five years because of the 'death panel' myth that erupted during the heated healthcare debate of 2009," Washington Post blogger Jason Millman wrote.

Components to successful end-of-life care include:

  • Frequently assessing the patient's physical, emotional, social and spiritual well-being

  • Offering referral to expert-level palliative care, or referral to hospice if the patient has a prognosis of six months or less

  • Round-the-clock access to coordinated care and services

  • Counseling of patient and family, as well as caregiver support

  • Regular personalized revision of the care plan and access to services based on the changing needs of the patient and family

"Health sys­tem managers, payers, and policy makers, likewise, have a responsibility to ensure that end-of-life care is compassionate, affordable, sustainable and of the best quality possible," the report states.

The report comes just after Joan Rivers' death sparked discussion about end-of-life care and informed consent. A report released in June found Medicare patients experienced improvements in end-of-life care, with chronically ill beneficiaries in their last six months of life spending fewer days in the hospital and receiving more hospice services in 2010 than in 2007, FierceHealthcare previously reported.

To learn more:
- check out the report
- read the NYT article
- here's the Washington Post blog post

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