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"Advance care planning" conversations

Doctors are at the center of the health events that begin the end of life experience. How do we make the most of this "launching point?"

Photo of Jim Rosenberg

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End of life conversations and decisions seem to start with some health event that marks the transition to this new phase of life. Doctors are at the center of those health conversations, but our healthcare system doesn't provide the right support for end of life conversations. This article and survey, Doctors Unsure About How To Talk With Patients About End-Of-Life Care, highlights the need for incentives (to compensate for a doctor's time), training, and new norms in healthcare.  A few highlights:

  • Medicare now reimburses doctors $86 to discuss end-of-life care in an office visit that covers topics such as hospice, living wills and do-not-resuscitate orders. Known as "advance care planning," the conversations can also be held in a hospital.
  • While 75 percent of doctors said Medicare reimbursement makes it more likely they'd have advance care planning discussions, only about 14 percent said they had actually billed Medicare for those visits.
  • Three quarters also believe it's their responsibility to initiate end-of-life conversations.
  • Fewer than one-third reported any formal training on end-of-life discussions with patients and their families.
  • More than half said they had not discussed end-of-life care with their own physicians.

What is a provocation or insight that might inspire others during this challenge?

Where are the gaps in our social systems that place constraints on the end of life experience? Can we identify them and come up with ways to change those constraints?


Join the conversation:

Photo of Morgan Meinel

Jim, thank you for shedding light on this incredibly important topic!  Like you noted, most physicians have not had any formal training in the area of end of life conversations. It takes compassion and skill to have these difficult conversations, but they are so vital. A Palliative Care physician at Mount Sinai I work with created this video that illuminates really helpful tips on how to conduct meaningful goals of care conversations with patients and their families: 

Photo of Jim Rosenberg

Morgan -- thanks for sharing this video, this is great. It reminded me of my own experience with the worst and the best ways these conversations can go with doctors. I think there are interesting ideas here for *anyone* talking with people at the end of life about things that are hard to talk about. Do you want to add this video as a separate post in the challenge (you can link it back to this post as an "inspiration" so people can explore the different threads)? 

Photo of Morgan Meinel

Thank you for your thoughtful response, Jim! I agree - how can we utilize the advice from these training tools and apply them more universally to conversations regarding illness, advanced care planning, and end of life concerns with our loved ones? Great questions. I added the video to a separate post - I hope others may find guidance in it! 

Photo of Hattie Bryant

Good for Dr. Meier.  She is a thought leader and real champion for the best care.

Photo of Morgan Meinel

Agreed, Hattie! :) 

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