IOM urges America to better serve the dying

The country with the sixth highest quality of life has an abysmal system for taking care of people drawing near to the end of their lives. Riddled with perverse incentives for aggressive care that patients often don’t want, the system may intensify rather than relieve suffering—and it surely adds substantial cost.

That’s the bad news. The good news is that there’s plenty of evidence showing that broad, cost-effective improvements to palliative end-of-life care are within reach.

Such is the conclusion of a 21-member nonpartisan committee appointed by the Institute of Medicine.

In a 507-page report that drew wide media coverage upon its release last week, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,” the IOM committee suggests lower costs would be a happy side effect of facilitating end-of-life care planning at societal, community and individual levels.

Some observers noted that the report’s discussion of saving money in the context of improving end-of-life care could renew fears of government bureaucrats, on orders to implement Obamacare, collaborating with insurers to pressure patients and families to decline life-sustaining treatments.

But others say the report can be read as a repudiation of concerns about the approach of “death panels.” And indeed, far from handing decision-making over to the government, the IOM recommendations call for incentivizing “the integration of medical and social services, the coordination of care across multiple care settings, and the use of advance care planning and shared decision-making to better align the services patients receive with their care goals and preferences. This reorientation will improve access to services that better respond to the needs of patients and their loved ones and may also help stabilize health care costs.”

The report stresses the need to encourage Americans to think about end-of-life wishes often, beginning as early as their mid to late teen years. It notes the rapid aging of the population and cites a 2013 survey that found 90% of Americans believe it is important to have end-of-life care discussions with their families, yet less than 30% of respondents had done so. Meanwhile, some 85% of hospitals with more than 300 beds now have palliative care services, yet patients who are not hospitalized may lack access. In response, the IOM report calls for training in, and accrediting for, palliative care across all medical specialties.

Sean Tutton, MD, a Milwaukee radiologist who teaches at the Medical College of Wisconsin and whose subspecialties include hospice and palliative medicine, says radiology has an important role to play in improving America’s end-of-life care system.

“Because of my understanding of palliative care, I will see a patient in my clinic who I know is an end-of-life patient or a patient who has an advanced cancer and I can make the palliative care referral earlier,” he told Interventional Oncology 360 in a recent interview. “When you make a palliative referral earlier, there’s data that says that you can prolong survival in certain cancers, so again, by working together, we’re actually benefiting the patient tremendously.”

To access the IOM’s “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,” click here