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Discussing end-of-life care with your patients

December 1, 2016

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It seems not a week goes by without hearing something on the news about improving end-of-life care for your patients. Whether it is social media, TED talks, medical blogs, celebrity doctors, or old-fashioned newspapers, the public conversation about death and dying has certainly risen decibels in the past decade. One frequent thread of this discussion has been how physicians discuss death and dying with their patients. Delivering sad news to patients that includes discussing end-of-life options can be very difficult for the patient, their family members, and providers ? particularly in a busy office practice. With this thought in mind, we want to thank you for your care of Independence members and, whether you are newly trained or a seasoned physician, we hope the information below can help with discussions of mortality.

Care options

Identifying what is important to the patient and what he or she values during the end stages of their life is essential to making your patient feel acknowledged, comfortable, and respected during an extremely challenging and emotional time.

End-of-life treatments are designed to keep the patient as comfortable as possible. Both palliative care and hospice care provide comfort measures.

  • Palliative care: Care can begin at the time of diagnosis and can be provided during the same time as treatment.
  • Hospice care: Care is implemented after treatment of the disease has ended and it is evident that the patient?s likelihood of survival is less than six months.

Hospice care focuses on caring for patients whose primary goal is comfort as they near the end of life rather than curative interventions. Hospice care is typically provided at home, at a hospice center, in a hospital, or in a skilled nursing facility. Hospice is a covered benefit for commercial managed care members. Medicare Advantage members may receive hospice care from any Medicare-certified hospice. Payment is made by Original Medicare. Members should consult their Evidence of Coverage for details.

With hospice care, an individualized care plan is developed to keep the patient as comfortable as possible, taking into consideration the physical, emotional, and spiritual pain that often accompanies terminal illness, as well as offering support to the caregiver(s) during the illness and grief support after the death of their loved one.

Tips for an effective discussion

If you have not had the experience yet of having an end-of-life discussion with your patients (or would appreciate a refresher), here are some key tips in helping prepare for the conversation:

  • Do not rush the conversation.
  • Hold the discussion in a private, quiet place where everyone can be seated comfortably to participate in the conversation.
  • Discuss the patients? diagnosis, including what the patient understands and the expected prognosis.
  • Identify the patients? goals for end-of-life care and discuss their advanced directives. If they do not have an advanced directive, encourage them to make one.
  • Discuss the differences between palliative care and hospice care and engage the patient and their family in a thoughtful conversation about which course of action is best for the patient.
  • Become familiar with your local hospital Palliative Care team and how to refer to them.

End-of-life care can be met with many challenges, but having thoughtful and meaningful conversations with patients and family members can help them make decisions that are beneficial for the patient to live the remaining part of their life in comfort and with dignity.

Visit our website to access additional provider and member resources to assist you with end-of-life discussions and decision-making.

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