Program changes how doctors talk to patients about death

A new program developed by Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health encourages physicians to talk to patients about their end-of-life wishes.

Too often, discussions between doctors and patients about death focus on medical treatments, but not on the patient’s experience and end-of-life wishes. A program put together by Ariadne Labs, a joint innovation center between Brigham and Women’s Hospital in Boston and the Harvard T. H. Chan School of Public Health, is changing that so that at the end of life, a patient’s wishes and experience are aligned.

Patients, families and clinicians need to discuss end-of-life wishes and document that conversation so it's readily available for caretakers, write three doctors involved in the program, Joshua Lakin, M.D., Rachelle Bernacki, M.D., and Rebecca Cunningham, M.D., in Harvard Business Review.

The team at the lab created a systemic, multistep intervention called the Serious Illness Care Program, which suggests questions clinicians should ask patients, such as which abilities patients can’t imagine living without and how much they are willing to go through to gain more time.

The program began in six primary care practices at Brigham and Women’s, where doctors, nurses and social workers were trained to hold conversations with patients about their values, priorities and goals at the end of life. It has since been expanded to include hospitalists, as well as oncology, nephrology, and other settings across the country.

A recent survey found that physicians who received training and those whose healthcare systems implemented a formal system for addressing end-of-life issues were more likely to initiate discussions with their patients. Although Medicare has introduced a benefit encouraging physicians to initiate voluntary conversations, the April survey found that honoring the wishes of the patient remains the primary motivating factor for most clinicians to have these conversations.