How to discuss patients' end-of-life wishes

Although it's been 25 years since the passage of the Patient Self-Determination Act, most physicians are still likely to provide higher intensity care at the end of patients' lives than they would want for themselves. Part of the reason for this disconnect is patients rarely discuss end-of-life wishes with their doctors.

More than 88 percent of physicians would opt for a "no code" or "do not resuscitate" status if they became terminally ill, according to a survey of 1,081 subspecialists finishing their clinical training at two academic hospitals, Medscape Medical News reported.

Separate research, however, indicates that less than half of terminally ill patients have advance directives, WKNO public radio reported, adding that of the people who do have them, between 65 and 76 percent of their doctors don't know about them.

The industry needs to increase efforts to better promote advance directives among physicians and patients alike, Adrienne Mims, M.D., MPH, chief medical officer and vice president of Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, told Medscape.

"We should be seeing better management of patients at the end of life, but we are not," she said. "Clinicians have not been trained for these conversations."

One national teaching program called "Respecting Choices" aims to change this scenario. The University of Tennessee Health Science Center recently rolled out the program, which allows students to role play with actors trained to bring up concerns that real people have when making end-of-life decisions, according to WKNO.

And the program doesn't just teach students to ask patients about their wishes should an accident or illness leave them in severe condition with no ability to communicate, but also how to educate patients about what various life-sustaining procedures involve. Clinicians are trained, for example, to give patients statistics about CPR, which works with about 17 percent of patients, usually those who are young and fairly healthy.

The program isn't about persuading people to make decisions recommended by doctors, but to just encourage clinicians to bring up the matter of dying before it's too late, according to Teresa Britt, director of professional education and clinical simulation at UT Health Science Center.  

To learn more:
- read the article from Medscape
- see the report from WKNO