End-of-Life Conversation Stoppers Revealed in New Survey

Megan Brooks

April 15, 2016

A new poll has found that the vast majority of primary care physicians, oncologists, pulmonologists, and cardiologists who see Medicare patients think end-of-life and advance care planning conversations are important, but many report significant barriers to having these discussions with their patients. And nearly half admit feeling unsure about exactly what to say.

In January 2016, as part of the Medicare physician fee schedule, the Centers for Medicare & Medicaid Services (CMS) began reimbursing health providers for leading these discussions. The benefit covers multiple conversations and is not limited to patients near death.

The new poll finds that physicians are overwhelmingly in favor of this new benefit (95%), although only 14% said they have billed Medicare for an advance care planning conversation since reimbursement kicked in.

The poll, called "Conversation Stopper: What's Preventing Physicians From Talking With Patients About End-of-Life and Advance Care Planning?" was commissioned by the John A. Hartford Foundation, the California Health Care Foundation, and Cambia Health Foundation. It included 736 primary care physicians and oncologists, pulmonologists, and cardiologists in 50 states. All of them see Medicare patients, and most (74%) report seeing many patients who could die within a year.

Three quarters of the physicians polled believe they have a responsibility to initiate candid end-of-life conversations, and a similar percentage predicted that Medicare reimbursement for these conversations would make them more likely to bring up the topic. Yet barriers clearly exist. For example:

  • Only three in 10 doctors (29%) report that their practice or healthcare system has a formal system for assessing patients' end-of-life wishes and goals of care.

  • Less than a third (29%) report having had any formal training specifically on talking with patients and their families about end-of-life care.

  • Only one in four (24%) says there is no place in their electronic health record indicating whether a patient has an advance care plan, and for those who do, a little more than half (54%) say they can actually access the plan's contents.

Training seems to be the key, according to physician responses.

Those who reported having explicit training in end-of-life conversations were more likely to find end-of-life discussions rewarding than their peers who did not have this training (46% vs 30%).

The poll also shows that physicians' concerns about initiating these tough conversations also stem from their commitment to their patients. Many say they did not want an advance care planning conversation to cause patients to feel the doctor was "giving up" on them (48%) or to "give up hope" (46%).

Yet at the same time, the poll shows that physicians value advance care planning as a way to honor their patient's values and wishes (92%), reduce unwanted hospitalization near the end of life (87%), and have patients and families feel more satisfied with their care (81%).

"As a primary care physician, I've had end-of-life conversations with patients for more than two decades," Sandra R. Hernández, MD, president and chief executive officer of the California Health Care Foundation, said in a news release. "As health care delivery becomes more patient-centric, this improvement in communication can relieve significant pain and suffering for patients and their families. These conversations, though not easy, benefit from taking into account the patient and physician's knowledge, attitudes, and beliefs about end-of-life care options."

More information about the survey and its findings is available on the John A. Hartford Foundation website.

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