Talking to your doctor about how much intensive care you want at the end of life is associated with a more peaceful death and significant savings.
Researchers at Dana-Farber Cancer Institute asked 603 cancer patients whether they had talked to their doctor about the care they would like to receive if they were dying. They found that patients who did not discuss their wishes were more likely to go on a ventilator or have other agressive procedures, experienced more physical and mental pain and did not live longer than patients who did talk about a care plan with their physician. The study’s senior author, Holly Prigerson, says a moderate increase in such conversations could save $76 million a year just among cancer patients.
“So it’s an unusual circumstance of a win win. When there are cost savings, it’s usually associated with some pain. Here, its literally the opposite, there’s more palliative, better quality of life, with lower costs.”
The study is in the latest issue of Archives of Internal Medicine.
Martha Bebinger
This is not new news; the Pew Studies on end-of-life care since the 1990’s have told us pretty much the same things.
This is why we need an actual health care system so that this type of knowledge can and will be acted upon on a large scale and over the long-term. This country needs reform that moves us toward improved Medicare-for-All with reimbursement reform so that clinicians are paid for value (including talking with a dying patient and their family) not volume of care, where the profit-motive is largely removed from the hc system).
Only when we have a functional humane hc system–where the primary system drivers are ordinary people’s physical health and well-being and their financial health (the 2 are interconnected)–will we begin to effectively address these hugely important issues such as improved end-of-life care.
I suggest you do what you can to get your members of Congress to include a strong public insurance option in this year’s health reform bill. That would be a good start. Also look at http://www.engagewithgrace.org
Martha, thanks so much for blogging on this article. It is one of a number of very important articles on palliative and end of life care that have been published this week. I agree with Helen that at one level “we know this.” Yet, once again our publics could ask, “if you knew, why didn’t you do something.” We all see, hear and read the stories of “bad deaths” where wishes were not considered and / or respected and resources consumed that were neither wanted nor value added. Our processes of care—primary to tertiary—must be designed to include discussions on our preferences at the end of life. It’s in the best interest of the patient, the family, and those who care for both and highly respectful of both their wishes and the appropriate use of expensive resources.
End of life care is an essential part of health reform. We’ve highlighted it in Massachusetts for more than two years under the Commonwealth’s Quality and Cost Council and it was emphasized last week at the White House. As part of our efforts, the QCC is proudly working to support and bring focus to National Healthcare Decisions Day. This Initiative is a collaborative of national, state and community organizations committed to ensuring that all adults have the information and opportunity to communicate and document their healthcare decisions. We encourage everyone to join us in this effort. http://www.mass.gov/?pageID=hqcctopic&L=3&L0=Home&L1=Consumer&L2=Public+Annoucements&sid=Ihqcc If you are a leader of an organization not already engaged please join us.
Among many organizations, the research team at DFCI (yes, I’m proud alumni) has been bringing exceptional clarity over the last year to the power and potential of care at the end of life: our mental models are flawed, most patients want to talk about it, and when they do there are huge rewards for the patient, the family, and society. It is time to join us on National Decision Day and it’s time join in the design of a new respectful system of care.
Jim Conway, SVP IHI
Comm of MA Quality and Cost Council