Choice at end of life. #PFD

[John Gear]

> latimes.com/health/boostershots/la-heb-end-of-life-20130320,0,4708259.story
>
> Patients should decide what the end of life is like, study says
> By Mary MacVean
>
> 1:30 PM PDT, March 20, 2013
>
>
> Finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars, UCLA researchers said Tuesday.
>
> �You can improve care while reducing costs by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,� Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, said in a statement.
>
> Bergman and colleagues wrote an article advocating for patient-centered care at the end of life in the journal JAMA Surgery.
>
> People who are dying often receive care that is poorly coordinated and not in line with the patient�s values or goals, the journal authors said. That should change, they said.
>
> Studies have shown that when a patient�s desires are taken into account, death is less likely to occur in an intensive care unit, physical distress is reduced, and death comes no sooner, they wrote.
>
> Thirty percent of Medicare�s resources are spent each year on the 5% of recipients who die, the authors said.
>
> Policymakers can make changes by including the importance of patient-centered care in education. �Our curricula reflect our priorities as a medical community, and we should show that we value end-of-life care by teaching it to each trainee,� the authors wrote.
>
> Medicare also should address this issue, to make sure that aggressive care goes to people who want it but not to those who do not -- saving money and improving care. And hospital ratings of quality and safety should also take end-of-life care into account, the authors said.
>
> �Surgeons can lead this effort: At UCLA, all urology residents are receiving education about end-of-life care, using online, problem-based, patient-centered modules,� the authors said.
>
> Researchers are working with cancer patients being treated at the West L.A. Veterans Affairs Medical Center, determining their goals and integrating a palliative care specialist at the outset of care.
>
> Too often, Bergman said, there has been no such discussion. �Then a lot of very aggressive treatments can occur due to inertia. Patients are placed in an intensive care unit with oxygen and feeding tubes, and that�s not always in line with their goals.�
>
> @mmacvean on Twitter