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Study supports doctor-led approach to end-of-life care planning

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By Hook Law Center

The end of a person’s life is a time of intense transition and difficult choices. Although nothing can fully prepare an individual or a family for the gravity of the decisions that need to be made, end-of-life care planning can help ensure that a dying individual’s wishes about his or her care are followed.

Traditionally, family conversations have led this process. Relatively few Americans have written advance health care directives. A recent study suggests that incentivizing physicians to discuss end-of-life care could boost participation in end-of-life care planning dramatically.

In the study, palliative care specialist Dr. Joshua Lakin and a team of his colleagues at the University of California, San Francisco (UCSF) Medical Center instituted an incentive program to improve documentation of patients’ advance care decisions.

The researchers developed a standard form, which was placed in patient’s electronic medical records. The form documented preferences, including whether the patient would like to be resuscitated, intubated, receive a feeding tube or receive all care in the case of major health decline. The forms also had room to list the patient’s health care agent and that person’s contact information, as well as a space for “expressed wishes” and any existing living will or health care directive.

Medical residents would receive a monetary bonus if, as a group, they completed preference forms for at least 75 percent of discharged patients during at least three out of the four quarters. Email alerts were sent to residents if they fell behind.

In July of 2011, 22 percent of the patients had documented preferences. By October of that year, 90 percent of patients had documented preferences, and the number stayed that high.

Although family conversations about end-of-life care remain important, this study suggests that in the future, a doctor-led approach may help ensure that these tough decisions are made and documented.

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Posted on Friday, January 23rd, 2015. Filed under Long-Term Care.