Is end-of-life care threatened by today’s healthcare environment? – Part 3

FOUNDATION 2: Physician-Patient Communication

There is a definite lack of physician-patient communication about death and dying, a conclusion supported by the Dying in America report, which named it “the most striking area in need of quality improvement”²² for patients nearing the end of life. If doctors and patients don’t talk about end-of-life choices, appropriate referrals for compassionate care don’t occur when they are needed.

In healthcare today, patients may receive the type of quality, compassionate care at the end of life as envisioned by Dr. Saunders if they are referred in a timely manner to a hospice that focuses on patient-centered care. The National Hospice and Palliative Care Organization²³ (NHPCO), however, reports that in 2017, less than half of patients nearing the end of life were referred to hospice by their physician and most of them received care for just seven days or less. In addition, a recent survey²⁴ found that only 16 percent of physicians reported having had end-of-life conversations with their patients.

“Fifty percent of patients are in hospice for 12 days or less. Twenty-five percent are in hospice less than three days— meaning costly curative treatments are taking place in the hospital setting. Research shows that quality of life improves and costs decline when patients are referred to hospice earlier. Most people want to die with peace and dignity in their home surrounded by loved ones—but this isn’t happening,” said Anderson.

Moreover, when physician-patient communication is poor, overtreatment can result. Dr. Byock writes: “Any doctor who dreads talking to patients about dying—and that describes a large majority—quickly learns that ordering more tests and treatments allows him or her to refocus on the disease and sidestep in-depth discussions with patients and their families about these morbid (or mortal) subjects.”²⁵ Thus, the cost of care at the end of life increases when physician-patient communication is absent.

Hospices should encourage physician-patient communication by providing resources to the medical community.

Dr. Atul Gawande writes: “Our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.”²⁶

Hospices can do a much better job of encouraging physician- patient communication by providing education and resources to healthcare providers. Some for-profit hospices, however, are sidestepping the need to support and encourage this appropriate physician-patient communication. They have been reported for increasing their census by actively recruiting patients who may not have a life-limiting diagnosis, thus shifting financial resources away from the dying patients who need care to simply maximize their profits. Some of these for- profit organizations have been indicted for Medicare fraud after paying physicians to “certify patients as hospice eligible without examining the patient or reviewing medical records.”²⁷

SUMMARY: When the profit motive takes precedence over the needs of the patient, everyone suffers the consequences. Returning to the foundations of hospice care will ensure that patients who need quality, compassionate end-of-life care can receive it in a timely mannaer.