Doctors Says Talking With Patients About End-Of-Life Care Difficult But Very Important


Many doctors say they don’t know what to say to patients

A new survey reveals that majority of doctors say they frequently or sometimes feel unsure of what to say to patients about end-of-life and advance care planning conversations.

All physicians are agreed that these discussions are very important. But they also report significant barriers to having these conversations with their patients.

The survey, Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning, involved 736 primary care and specialist physicians in 50 states, including oncologists, pulmonologists, and cardiologists.

Discussions about end-of-life care are important, helping people learn about their health care treatment options, figure out the type of care they want, and share those wishes with family, friends, and providers.

The Centers for Medicare and Medicaid Services is reimbursing doctors and other professionals for leading these discussions. The benefit covers multiple conversations and is not limited to patients close to death. According to the poll, 95% physicians support the new benefit. Also, there is a strong support for this benefit among the public.

What’ll be the long-term impact of the new Medicare? Answer to this question is still unclear, but 75% of physicians predict that it would make them more likely to talk with older patients about advance care planning.

“Too many people at the end of life receive care that is completely at odds with their personal wishes,” Terry Fulmer, president of The John A. Hartford Foundation and a nurse, said in a statement. “The new benefit, with its strong support from clinicians, is a promising first step in ensuring that more people remain in control of their health care experience to the very last day of their lives.”

Despite recognizing the importance of these discussions, physicians say there are numerous barriers that get in the way.

Around 29% say that their practice or health care system has a formal system for assessing patients’ end-of-life wishes and goals of care. Less than one-third report having had any formal training specifically on talking with patients and their families about end-of-life care. One in four says there is no place in their electronic health record (EHR) indicating if a patient has an advance care plan, and for those who do, a little more than half say they can actually access the plan’s contents, according to a statement.

There will be a second phase of this polling project, focusing on exploring these and related barriers in more detail.

“As a primary care physician, I’ve had end-of-life conversations with patients for more than two decades,” said Sandra R. Hernández, MD, President and CEO of the California Health Care Foundation. “As health care delivery becomes more patient-centric, this improvement in communication can relieve significant pain and suffering for patients and their families. These conversations, though not easy, benefit from taking into account the patient and physician’s knowledge, attitudes, and beliefs about end-of-life care options.”

Many physicians say that they didn’t want an advance care planning conversation to cause patients to feel the doctor was “giving up” on them or to “give up hope.”

“Reimbursing doctors to have these conversations is only part of the equation. It’s equally important that consumers are empowered by these conversations and feel their wishes are expressed and respected,” Peggy Maguire, Cambia Health Foundation President and Board Chair, said in a statement.