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Health System Not Meeting End-of-Life Needs

The U.S. health care system is not properly designed to meet the needs of patients nearing the end of life and those of their families, according to a September 2014 report from the Institute of Medicine. The report says that major changes to the system are necessary.

A release from IOM notes that the 21-member committee that wrote the report envisioned an approach to end-of-life care that integrates traditional medical care and social services and that is high-quality, affordable, and sustainable. The committee called for more “advance care planning” for end-of-life by individuals, for improved training and credentialing for clinicians, and for federal and state governments and private sectors to provide incentives to patients and clinicians to discuss issues, values, preferences, and appropriate services and care.

The release quotes Philip Pizzo, co-chair of the committee and David and Susan Heckerman Professor of Pediatrics and Microbiology and Immunology and former dean of medicine at Stanford University, as saying, “Patients can, and should, take control of the quality of their life through their entire life, choosing how they live and how they die, and doctors should help initiate discussions with their patients about such decisions. For most people, death does not come suddenly. Instead, dying is a result of one or more diseases that must be managed carefully and compassionately over weeks, months, or even years, through many ups and downs. It is important that the health care options available to individuals facing the end of life help relieve pain and discomfort, maximize the individual’s ability to function, alleviate depression and anxiety, and ease the burdens of loved ones in a manner consistent with individual preferences and choices.”

Americans express strong views about the care they want to receive when they are seriously ill and approaching death. In general, they prefer to die at home and want to remain in charge of decisions about their care. However, the vast majority of Americans have not engaged in an end-of-life discussion with their health care provider or family. A 2013 national survey of adult Americans found that while 90 percent believe having family conversations about end-of-life wishes is important, fewer than 30 percent have done so.

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