Increased Physician Education to Increase End of Life Conversations
This year, the Centers for Medicare and Medicaid Services (CMS) will begin to reimburse physicians and nurse practitioners for discussing end-of-life care with their patients. With the increase in these types of conversations, it is important to ensure that doctors have access to the tools and training to do their job effectively. Dr. Michael Nisco recently published a piece in the Washington Post highlighting some of the steps that are being taken to fill this need.
According to the American Medical Association, less than 30 percent of residency programs in the US offered any type of course on end-of-life care in 1999. In a recent survey, only 8 out of 122 medical schools surveyed had mandatory training in end-of-life care. This lack of training has led to physicians either delaying or avoiding the topic with terminally ill patients.
The recent decision by CMS has helped to shed more light on a movement which has gained momentum in recent years. In 2014, Massachusetts became the first state to legally require doctors to discuss end-of-life care with terminal patients. Additionally, in September 2014, the Institute of Medicine released the report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. There is also a movement led by the Conversation project to encourage families and friends to talk about end of life care more openly.
Dr. Atul Gawande has written extensively on the subject end-of-life care in his book “Being Mortal,” which was also the topic for an episode of PBS Frontline of the same title. In his book, Dr. Gawande draws from his experience with both his patients and his family and explores the complex relationship between doctors and the terminally ill patients they serve.
With all the research highlighting the need for these conversations, what can be done to ensure current and future doctors are prepared? Dr. Nisco focuses on the need for palliative care training starting in medical school. Students should be taught and tested on how to treat terminal patients, and develop not only the technical knowledge, but the communication skills required to discuss the topic with patients and their families.
The ultimate goal of these conversations is to ensure that doctors are not only treating the physical needs of a patients but also addressing their cultural, psychological and spiritual needs so they can die with dignity.