End of Life Scare

Hoping to spur dialogue about end of life care with patients, the federal government this year began reimbursing doctors for starting – and continuing – conversations about dying.

But there’s just one problem. Many doctors are afraid to talk about death.

In January, the national Centers for Medicare & Medicaid Services – which oversees regulations and payment for older adults, the disabled and poor – began reimbursing doctors and other healthcare professionals for discussing advanced directives and end of life care with all elderly patients – not just those close to death.

Yet almost half – 46% — of the physicians surveyed in Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning? said they were “frequently” or “sometimes” unsure about what to say to patients about end of life plans.

The biggest reason for this uncertainty? Fear.

Not only are doctors afraid to discuss the taboo topic, they don’t want patients to think they’ve given up on them, or will give up hope if the patient becomes critically ill.

At the same time, doctors fully support the reimbursement policy. Nearly all of those polled (95%) support the reimbursement, while three-quarters said it would help them start conversations about advanced directives and the dying process.

Meanwhile, only 14% of those polled had actually billed Medicare for such a conversation.

California’s End of Life Option Act, which legalizes “assisted dying” under strict conditions, was signed by Gov. Jerry Brown last fall. It takes effect June 9.

The survey of primary care physicians and specialists with Medicare patients also found that today’s medical system is ill-prepared for these kinds of talks.

Only about three in 10 clinicians had any formal training in having end of life discussions with patients. Seven in 10 said their practice (or health care system) had no formal plan for such discussions

“As health care delivery becomes more patient-centric, this improvement in communication can relive significant pain and suffering for patients and their families,” said Dr. Sandra R. Hernandez, president and CEO of the California Health Care Foundation, one of three organizations sponsoring the survey.

Cambia Health Foundation and the John A. Hartford Foundation also co-sponsored the survey, which polled 736 primary care physicians, oncologists, cardiologists and pulmonologists in all 50 states.

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