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End-of-Life Care in Hospitals Has a Long Way to Go

Analysis  |  By Tinker Ready  
   June 16, 2016

Many doctors and patients don't talk about how to handle the pain, disability, or despair that may accompany a serious illness or imminent death. Hospital leaders can push for greater competency in advanced planning among clinicians.

Medicare may reimburse primary care physicians for end-of-life talks with patients, but those conversations between seriously ill patients and their doctors often don't occur, even when patients are being treated for serious illnesses.

A survey by the Massachusetts Coalition for Serious Illness Care shows that 85% of Massachusetts residents believe that physicians and their patients should talk about end-of-life care, but only 15% have actually had such conversations.

Working with healthcare delivery systems will be one of the coalition's most important tasks, according to Atul Gawande, the coalition's co-chair and a surgeon at Brigham and Women's Hospital in Boston.

Related: Click to see the Survey

Gawande, who responded to email questions from HealthLeaders, is also author of the bestseller on end-of-life care, Being Mortal.

"Hospital leaders have an opportunity to reduce suffering and improve patient well-being by making these conversations a routine part of care," he wrote.

"To do that, they can train clinicians to have these conversations, adopt processes to identify at-risk patients who would most benefit from these conversations, and invest in systems that support the clinicians, patients, and families."

Some forms of end-of-life care are improving, he acknowledges. The percentage of patients getting hospice services and other forms of palliative care has been rising steadily.

The more persistent problem, however, is poorly executed or over-aggressive end-of-life treatment, which may occur well before a patient qualifies for hospice.

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Those with serious or chronic conditions may not want more therapeutic care if it means a reduced quality of life, a painful procedure, or an expensive long shot at a cure.

Related: Quality of Death Equals Quality of Care

The survey suggests that many doctors and patient don't routinely talk about how to handle the pain, disability, or despair that may accompany a serious illness or imminent death. 

Training providers to have those conversations is the biggest challenge of improving end-of-life programs, says Patricia M. Noga, the vice president for clinical affair for the Massachusetts Hospital Association, which is a member of the serious illness coalition.

Everyone on the care teams need to be both competent and comfortable talking to patients, she says.

Tinker Ready is a contributing writer at HealthLeaders Media.

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