Lack of physician training still hampers end-of-life conversations

By Matt Kuhrt

Despite strong agreement among physicians about the importance of discussing advance care planning with patients, a number of factors persist in keeping those conversations from taking place, according to survey data released jointly by the John A. Hartford Foundation, the California Health Care Foundation and the Cambia Foundation.

The aging of the baby boomers has generated sufficient focus on the need for end-of-life discussions between doctors and patients that Medicare introduced a new benefit encouraging physicians to initiate voluntary conversations. In the poll, 95 percent of respondents voiced support for the benefits and 75 percent said the program makes them more likely to initiate conversations.

That 99 percent of respondents consider these discussions to be important, yet a mere 14 percent of them actually initiated and billed for such discussions with their patients suggests "a huge disconnect," according to Anthony Back, M.D., of the University of Washington on a conference call Thursday announcing the survey results.

Physicians who received training and those whose healthcare systems implemented a formal system for addressing end-of-life issues were not only more likely to initiate discussions with their patients, but also to characterize those discussions as rewarding, as opposed to challenging. According to the poll, however, fewer than a third of respondents reported having such support, suggesting structural barriers may well be keeping physicians' good intentions from translating into action.

Honoring the wishes of the patient remains the primary motivating factor for most physicians to have these conversations, so it's not surprising that giving them the appropriate tools would trump additional incentives. "Reimbursing doctors to have these conversations is only part of the equation," said Peggy Maguire, Cambia Health Foundation president and board chair, in an announcement accompanying the report. "It's equally important that consumers are empowered by these conversations."

To learn more:
- read the report
- see the announcement