While Medicare now compensates physicians for having conversations with their patients about advance care planning (ACP), to change attitudes about it requires community education, according to a Health Affairs blog post.
In the spring of 2016, a volunteer collaborative based in Washtenaw County in Michigan set out to identify the barriers faced by individuals and families when it comes to advance care planning--the process where people talk with their doctors and family members about their end-of-life care preferences and designate someone to carry out their wishes.
The Washtenaw Health Initiative held a series of focus groups and interviews with over 80 community members and physicians to learn about attitudes to advance care planning. Despite the fact that the county is one of the top 10 healthiest counties in Michigan, the leaders of the initiative learned the process is not generally accepted by its residents.
“ACP is not an accepted, understood part of the normal aging process, despite the fact that many residents have access to high-quality healthcare,” wrote researchers Claire Peters, Oliver Kim and Marianne Udow-Phillips, who also authored a white paper detailing their findings. They learned that community members strongly associate advance care planning with dying, not with choices about care.
Both community members and physicians were uncomfortable and uncertain about initiating conversations about advance care planning, the initiative leaders found. Physicians identified lack of adequate time and emotional discomfort as major barriers to starting conversations with patients, particularly when patients or family members were not ready. Several doctors also said they did not have the necessary training to initiate conversations with patients.
Medicare’s approval of reimbursement for these discussions provides some incentive for doctors, but additional guidance and training is still necessary, as FiercePracticeManagement reported. As a next step, the Michigan project is now developing a conversation guide for both health providers and community leaders to raise awareness and educate patients and families about ACP.
- read the article
- find the white paper