Contributor: Liz Eddy Scully
To learn more about Liz, click here.
Most healthcare providers want to support their patients in end-of-life planning and facing mortality. So, why is the topic of end-of-life so rarely discussed in the healthcare setting? And when it is discussed, why is it often in the last moments of life when it’s too late to make a legally sound plan?
In an era where death and loss are top of mind, it’s time we make dramatic changes to better prepare ourselves. After all, we are human and, like birth, death is one of the most human things we’ll experience. Americans are experiencing traumatic loss at a rapid pace. 57% of Americans are grieving a recent loss,1 with 1 in 3 Americans having lost someone due to COVID-192 alone. For each person who passes away, there are 9+ newly bereaved3 — who experience emotional and physical symptoms of grief.
Most adults recognize the need for an end-of-life plan, but few have created one. In fact, 6 in 10 U.S. adults have no plans in place for their end-of-life.4 Further, research has shown planning improves quality of care, patient outcomes, and the bottom line for the healthcare system,5 yet most people aren’t asked to do them by their healthcare providers until they’ve reached end-of-life, if at all.
Why has adoption of end-of-life planning been so difficult to implement in healthcare to date?
While there are many reasons to be cited, Lantern has found a number of repeating issues in our work with healthcare systems. These include:
- Death is treated as failure versus nature. Not only does this put extreme pressure on healthcare professionals to work miracles, this mentality has caused a massive lack of medical expertise in palliative care. Palliative care is not required in most medical schools or is treated as an elective course.6
- A big, unanswered question remains. Who pays for end-of-life planning services? Currently, there are CPT codes that cover discussion on end-of-life planning, but don’t require any resources to be provided to complete the paperwork. Free services are more palatable, but often liability concerns from the healthcare system get in the way of distribution of external resources.
- Cultural disagreement on when in the care continuum end-of-life planning should happen and who should be responsible for discussing it.
- EMRs (and other software) that don’t speak to each other. For healthcare systems that do have some form of end-of-life planning documentation in place, it’s often a challenge to find the documentation when it’s needed.
- Distrust in healthcare having your end-of-life plan. For many patients, decades of distrust in our healthcare system have led to concern in providing end-of-life plans. This stems from fear the paperwork will be misused, and necessary intervention won’t be taken.
What needs to happen for healthcare systems to successfully implement end-of-life planning services?
- Early patient exposure to end-of-life planning. Studies show the introduction of planning starting at 18 reduces anxiety and reluctance around future planning. It has been proven highly effective for GPs to be the first to introduce these documents, regardless of health concerns or age. For example, 96% of people who die in La Crosse, Wisconsin have an end-of-life plan, compared to ~30% nationally. As a result, La Crosse, Wisconsin spends less on healthcare for patients at the end-of-life than any other place in the country.7
- While individuals within healthcare are overwhelmingly positive on the idea of providing end-of-life planning resources, the decision to implement a solution needs to come from the top. Until it’s acknowledged that a good death is the responsibility of the healthcare system, no progress can be made.
- Better research needs to be made available. As of right now, there are a number of case studies showing healthcare savings when end-of-life planning is completed by patients. Still, no large-scale study has been completed proving the ROI and the detriments to individuals, families, and the healthcare system when plans aren’t put in place and properly utilized.
What can healthcare providers do right now to improve upon this issue?
- Educate yourself. Become literate in speaking about death and arm yourself with the resources to properly support and prepare every patient. Lantern has a great resource to get started.
- Make it a part of your routine. Practice these conversations with every adult patient, regardless of health concerns or age.
- Engage in larger forums on the topic. Discussing new offerings for your hospital? Involvement in research on improving quality of care? Speaking on a panel about healthcare outcomes? Part of the challenge in bringing better end-of-life care to patients is the lack of conversation around the topic at conferences, in the boardroom, in research, on panels, in the media and beyond. You have the knowledge now, so ensure this topic isn’t skipped next time you’re in a professional setting.
Contact Liz at: [email protected]