Having discussions about patients’ preferences for end-of-life care does not cause them harm or increase the risk that death will come more quickly, new research shows.
Patients who talk with their physicians about end-of-life care and have a so-called advance directive in their medical record have similar survival rates as patients who do not have these discussions and documents, according to a new study published Sept. 28 in the Journal of Hospital Medicine.
An advance directive is a legal document that enables individuals to state their decisions about the kind of end-of-life care they prefer ahead of time. These documents provide a way for patients to communicate their wishes to family, friends and healthcare professionals to avoid confusion or solve any problems at the end of life.
“[Advance directives] allow patients to express preferences that incorporate both quantity and quality of life, as there are times when interventions at the end of life may increase length of life to the detriment of quality of life,” the study says.
End-of-life care has been a subject of debate in light of federal healthcare reform, with the term “death panels” being used by politicians and in the media. First coined by former lieutenant governor of New York Betsy McCaughey, a Republican, in relation to a 2009 healthcare bill, McCaughey claimed the legislation would mandate counseling sessions for Medicare patients to tell them how to "end their lives sooner." The term “death panels” was more recently popularized by former Alaskan Gov. Sarah Palin, a Republican, in 2009.
“The term ‘death panels’ has sparked considerable controversy recently,” says Dr. Stacy M. Fischer, the study’s lead researcher and an assistant professor at the University of Colorado School of Medicine. “It has undermined the efforts of clinicians who provide end-of-life care by scaring patients into thinking that their lives may be cut short for their families’ or society's best interest.”
Fischer’s study included 356 patients admitted at three different Colorado hospitals who had low or moderate risks of dying within one year. Patients participating in the study were observed from 2003 to 2009. Throughout the study, there were no differences in survival for patients who had an end-of-life discussion and those who had not. Patients who had a living were also no more likely to die within a year than those who did not have one.
Out of the 356 patients who participated in the study, 206 – or 45 percent – reported that they had a discussion about advance directives with a healthcare provider. Out of the all the patients studied, 56 individuals – or 10 percent – had an advance directive document in their medical record, 6 percent had a living will, 43 percent had a power of attorney and 30 percent had a broader advance directive document. None of these things were found to have an impact on the patients’ survival rates, according to the study.
Patients who had discussed an advanced care directive or had such a document in their medical record were no more likely to die within one year than those that did not have or talk about such documents.
Fischer says the study is reassuring for both healthcare providers, who can initiate end-of-life discussions with patients, and patients and their families, who often need to have these types of discussions more often.
Legislation concerning advance care planning was removed from the Patient Protection and Affordable Care Act, the federal healthcare overhaul signed into law in March 2010. But through a Medicare payment regulation, the Centers for Medicare and Medicaid Services was able to add a provision allowing compensations to physicians as part of the annual Medicare wellness exam, a new free benefit offered to patients under the Affordable Care Act.
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