We live in a country where people are dying in a way that they would not choose, and loved ones are left feeling not only bereaved but guilty and uncertain. There is evidence to support that over 80% of people wish to talk to their physician and family about end-of-life wishes; however, under 30% have done it. It is also known that most people would prefer to die at home; however, only about 25% actually do. In 2015, just over 40% of Medicare beneficiaries received care for 14 days or less and the median length of stay was only 23 days.
There is a lot of aggressive care done in the United States and much of it is done at the end of one’s life. In fact, a quarter of all Medicare dollars are spent on the last year of life and most of that is within the last two months. The goals of aggressive care are for a cure, to feel better and live longer but in many cases, it decreases quality of life and most often, it shortens it. There was a study done by the University of North Carolina School of Medicine that looked at patients with five types of metastatic cancer (lung, colorectal, breast, pancreatic and prostate). Depending on the type of cancer, 71% – 76% of patients received some type of intensive care (chemotherapy, radiation, procedure, ER visit, hospitalization) in the last 30 days of life.
Reasons Conversations Do Not Happen
There are a variety of reasons why conversations don’t happen with physicians and among family members. Some of the most common reasons are:
- It’s counterintuitive for health care professionals
- Training is focused on saving lives
- There is a pressure to remain positive
- More tempting to say, “Let’s try something else”, instead of “Maybe we aren’t winning here”
- Seems to always be too early to start talking
Having the Conversation
It is important that conversations begin early so that patients and families are more educated and informed of all options and to try and prevent a conversation from trying to happen in crisis mode. There really is no right time but it is important that we have the conversation with the patient and family and ask him or her:
- How do you spend your day?
- If you couldn’t do this, would life still be worth it to you?
- What’s most important to you?
- What is unacceptable to you?
- What are your fears?
- What are you willing to sacrifice?
- What are you not willing to sacrifice?
- What are you willing to go through and what are you not willing to go through for the sake of more time?
- What’s the minimum quality of life that you would find acceptable?
Having these conversations can only benefit patients as it provides them with the truth so that they can make choices about how they want to spend their life. Conversations allow patients to be able to take control over their end-of-life experience and get involved with palliative care and hospice so that they can be assured quality of life.
Have Questions? We Have the Answers!
Our team at 5 Star Consultants is very knowledgeable about communication techniques and ways to train individuals, from physicians to clinicians, about how to have these conversations, which can often be uncomfortable and hard. Contact us today! We welcome the opportunity to speak with you about your training needs and the different solutions we offer. Please feel free to contact us at [email protected] or 866-428-4040.