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Protocols Needed For Palliative Care at End of Life

Cheryl Clark, for HealthLeaders Media, July 7, 2010

The U.S. paid hospitals and doctors $50 billion for care provided to Medicare patients during their last two years of life. One dollar in every 10 healthcare dollars is spent in the last year of life, and $2.70 of every $10 is spent by Medicare.

The researchers devised a list of 16 indicators for appropriate care in dying patients, and found that 30% of the time patients did not receive it.

For example, in more than half the vulnerable patients who were placed on mechanical ventilation, or admitted to the intensive care unit, there was no discussion documented in the medical record that their preferences of care was discussed with the patients and/or their family members.

The report notes that 75% of the patients who were enrolled in hospice or died an expected death had a defibrillator implanted, yet there was no discussion about whether the defibrillator should have been deactivated prior to death.

I know some people will miss the point, or choose to ignore it. For example, when a friend posted my story about the Archives study on his Facebook page last week, it provoked some comments about so-called "death panels" and former Alaska Governor Sarah Palin.

Wrote one person: "It seems like there has been a huge number of these stories coming out since the passage of Obamacare. [People are] talking about how services at the end of life are a waste of money," wrote one person in a comment.

"I can't help but think that this is propaganda aimed at convincing people that allowing their loved ones to die is better for society as a whole. Palin's 'death panels' are appearing faster than anyone had anticipated," commented the same person.

I responded to the writer that it wasn't about allowing a loved one to die. That was going to happen anyway. This is about making sure they don't die in pain, struggling to breathe, and that they aren't artificially kept alive much longer than they previously said they would want to be. And that it was about prompting doctors to have these discussions with patients and families in a more timely way, triggered by certain undisputed turning points in the patient's prognosis.

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