US Needs to Lift its Game on End of Life Care
In the USA too many patients have "bad deaths" because they do not get the care they need, said the President of the International Society for Advance Care Planning and End of Life Care on the first day of the Society's annual conference.
The conference being held at the Donald E. Stephens Convention Centre, Rosemont, Chicago has attracted health professionals from around the world who specialise in end of life health care.
"When doctors and nurses fail to listen to the real problems, from the patients' perspective, the patients and their families suffer," said Associate Professor, Dr Bill Silvester, an Australian intensive care specialist.
"If a patient's suffering is being addressed and they are being listened to and have some control over their future health care, then they are much less likely to resort to assisted suicide or request euthanasia," Dr Silvester said.
"Doctors are trained to preserve life, which is what we want. But people have the right to say "No" to aggressive interventions if it will not help them to live, as they would wish.
If the "best interests" test was applied more uniformly across the USA then there would be significant reductions in the numbers of people receiving medical treatments and procedures that will not help them and which they do not want but which they are subjected to simply because the technology exists.
The USA health system needs to get with the program. It should take the lead shown last week by the Massachusetts Senate which passed a bill requiring doctors to speak to patients who have been diagnosed with a terminal illness regarding their end of life care options. This process is called advance care planning and is at the cutting edge of health care reform around the world.
"This is a great move and has been supported by the Republicans and the Right to lifers compared to the proposed 2010 Affordable Care Act that President Obama tried to get through Congress but was sabotaged by Sarah Palin with her ill informed "death panel" fear campaign," Dr Silvester said.
A study by Dr Silvester and colleagues from the Austin Hospital in Melbourne, Australia published in the British Medical Journal, showed that the families of patients who do effective advance care planning are much less likely to suffer post traumatic stress disorder, anxiety and depression after the patient has died.
* There are significant variations in the use of health resources in the last 6 months of life in the US, without any clear improvement of care or outcome for the patient if more resources are used:
- Number of days in the hospital range from 9.4 to 27 days
- Number of days in the ICU range from 18 to 76
- Percent of deaths in the hospital range from 16 to 56 percent
* Five percent of the US population currently accounts for 50 percent of healthcare costs.
* Only 18 to 36 percent of Americans have created an advance directive providing instructions for medical care if the person is unable to speak for themself
* Over one-quarter of all Medicare expenditures are for treatment provided to patients in the last year of life. Of that, 40 percent occurs in the last month of life, 80 percent of it for hospital treatment.
* If effective advance care interventions were provided to the 5 percent of the US population that currently accounts for 50 percent of all healthcare costs, and even just 10 percent of savings were realized, it is estimated that $25 billion would be saved.
"Advanced care planning is not designed to save money. It is designed to get seriously ill people the care they want and need. Cost savings are an unintended side benefit," Dr Silvester said.
"As doctors, we must not avoid having difficult conversations or, worse, ignore patient wishes," Dr Silvester said.
The full conference program is available at http://acpelsociety.com/conference/