A report issued by the Dartmouth Atlas Project this year found that as people age, many continue to receive care that does not align with their own preferences.
This is especially true at the end stages of serious illnesses.
While many patients tend to prefer comfort measures over further medical interventions, the Dartmouth team reported that patients are spending more days on average undergoing aggressive treatments in the intensive-care unit, despite concerns over the value of such care.
Although excellent pain relief services are available for patients in need, the report also found that late hospice referrals occur too frequently—adversely affecting not only the quality of care delivered, but also the experience and satisfaction of patients and their families. Rather than rushing through a process of providing pain medications in these situations, hospice professionals need more time to get to know patients and families, building trust so they may truly address their needs.
In too many cases, efforts to prolong life can result in drawn-out, uncomfortable and even painful final days. While not an easy topic for anyone, the report sheds much-needed light on the fact that physicians must be comfortable discussing end-of-life care planning with patients. We owe it to them to respectfully open this dialogue and ensure their care decisions, goals and wishes are honored.
Although the CMS announced last year that it would begin providing reimbursement for end-of-life discussions with patients, they can still be incredibly difficult on a personal level for a clinician to initiate. As physicians, we are conditioned to develop meaningful, long-standing relationships to ensure our patients' health, making end-of-life issues so hard to broach. Patients are also often uncomfortable proactively sharing their feelings on the topic. But these conversations are essential. From an organizational standpoint, it can be challenging to implement practices that help physicians have these discussions, and to document their patients' wishes so they are available when needed.