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To Your Health: NLM update Transcript

Improving end-of-life communication and care: 04/27/2015

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I’m Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine.

Here is what’s new this week in MedlinePlus.

The U.S. health care system needs a range of reforms to better meet the needs of patients at the end-of-life, finds an insightful perspective recently published in the New England Journal of Medicine.

The perspective’s authors, who co-chaired an Institute of Medicine (IOM) report on end-of-life care, report mixed progress regarding the percentage of dying patients who are cared for at home or a care facility, as well as the percentage of end-of-life patients in hospice care.

For example, the authors report a comprehensive study of 848,000 Americans who died in 2000, 2005, and 2009 found acute care hospitalization declined from about 32 percent in 2000 to about 25 percent in 2009. At the same time, the authors (who are the former Dean of Stanford University School of Medicine and the former U.S. comptroller general) note the use of intensive care during the last month of life increased from about 24 percent in 2000 to 29 percent in 2009.

While the authors note hospice care increased from 2000-2009, they explain about 28 percent of end-of-life patients received hospice care for three days or less.

The perspective’s authors acknowledge two core challenges in end-of-life care remain when physicians override a dying patient’s wish to remain at home, or conversely agree to patient and family wishes to provide more end-of-life medical care than the provider finds necessary.

As the U.S. population ages and becomes more culturally diverse, the authors write (and we quote): ‘it is imperative that the medical community listen to patients and recognize that their end-of-life preferences may change over time especially as longevity increases’ (end of quote).

Among an array of suggestions, the authors explain physicians should initiate discussions regarding advance directives with patients at different milestones during their lives. For example, the perspective’s authors suggest physicians review advance directives (to see if a person’s preferences change) when a patient receives a driver’s license, is married, starts a new job or career, relocates, or becomes eligible for Medicare.

To provide needed reforms, the authors (and the IOM report) urge a comprehensive approach that includes changing individual and public education that will (and we quote) ‘allow patients and clinicians to have meaningful discussions about end-of-life planning’ (end of quote).

The authors add physicians should ensure their patients have access to skilled palliative and hospice care. The authors add physicians should collaborate… (and we quote): ‘with skilled palliative care specialists, whether doctors, nurses, social workers, or clergypersons, to ensure the best possible care of their patients’ (end of quote).

The authors (and the IOM report) provide a range of additional recommendations that include better national reporting on quality measures, outcomes, and costs regarding end-of-life care that could be initiated by federal agencies working with health care organizations, and insurers.

Overall, the authors emphasize (and we quote): ‘physicians should now practice what they profess, to ensure that their patients have the same options that they themselves, and a majority of Americans, would chose and that they honor patient’s preferences at the end of life’ (end of quote).

The IOM end-of-life report is available by typing ‘Dying in America’ in any search engine.

Meanwhile, MedlinePlus.gov’s end of life issues health topic page provides a number of resources about end-of-life care. For example, a website from IntellHealth/Harvard Medical School (which is focused on patient-provider communication) is available within the ‘coping’ section of MedlinePlus.gov’s end of life issues health topic page.

Helpful insights to better understand comfort and care at the end-of-life (from the National Institute on Aging) are available in the ‘start here’ section of MedlinePlus.gov’s end of life issues health topic page.

MedlinePlus.gov’s end of life issues health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about end of life issues as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s end of life issues health topic page type ‘end of life issues’ in the search box on MedlinePlus.gov’s home page, then, click on ‘end of life issues (National Library of Medicine).’ MedlinePlus.gov also contains health topic pages on hospice care and palliative care.

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