How a 6-Point Plan Could Improve End-of-Life Care

For doctors, having a difficult conversation with seriously ill patients and their families about end-of-life care can be understandably complicated, and physicians and the provider organizations they work with are looking for the best resources to help.

These conversations are important not only because the right decisions for end-of-life care can make a huge difference for seriously ill patients and their families, but because approximately 25% of Medicare expenditures have historically been allocated to last-year-of-life care.

Dr. Susan Block is the founding chair of the department of psycho-social oncology and palliative care at the Dana-Farber Cancer Institute in Boston and a palliative care expert. She is also the advisor to The Conversation Project, a grassroots campaign to help “people talk about their wishes for end-of-life care.”

Block has focused her work to not only having good conversations with her patients about end-of-life care, but she is helping train other doctors how to do it. After deciding to take a standardized approach to these conversations, Block developed the Serious Illness Conversation Guide with Ariadne Labs, a collaboration of Brigham and Women’s Hospital and the Harvard School of Public Health. 

Citing her own experience with her father’s end-of-life care, Block has underscored the importance of these difficult conversations.

“Doctors and patients alike fear having to discuss what the end may bring,” Ariadne Lab’s Serious Illness Care program website states. “However, we know that when physicians have the skills to initiate these difficult conversations early and honestly, the experience can be transformative for seriously ill patients and their families.”

The program’s Serious Illness Conversation Guide for doctors has seven questions to ask patients to better understand what type of care those with only a year or two of life left want to ensure they have the best quality of life. 

The key is for doctors to ask the right questions so patients understand their health situation, but don’t lose hope or feel crushed.

In Block’s approach, “The process begins with open communication.”

The program’s system has six focus points:

— Identify patients with a high risk of death within a year

— Train and coach physicians 

— Remind physicians to hold these conversations at the right time, before terminal phase

— A structured Serious Illness Communication Guide for supporting these discussions and planning

— Serious suggestions for end-of-life care preferences with family members

— Document the end-of-life plan in patient’s electronic health record 

Block has been using the program at the Dana-Farber Cancer Institute in Boston for two years as part of a four-year clinical trial, Modern Healthcare reported. Up to 400 cancer patients are being tracked over their remaining years as part of the study.

Doctors and trial organizers identified patients earlier in their diseases in order to ease patients’ minds about the idea of palliative care.

Block noted that the most important questions to ask patients about care are ones related to minimizing suffering and spending more time with family, rather than focusing on procedures.

Study results have not yet become available, but Block says that end-of-life conversations are increasing, and there are talks for the program to be implemented in more than 20 hospitals where palliative care is hotly debated. 

While doctors are still figuring out the best methods for making medical decisions with seriously ill patients, it is clear that it is crucial to hold these conversations early, before the terminal stage, and to ensure patients do not lose their spirit.

Written by Amy Baxter