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Discussions associated with longer survival rates and better
quality of life
Philadelphia, November 10, 2014 -- Physician-patient
communication about goals of care is a low risk, high value
intervention for patients with a life threatening illness, the
American College of Physicians (ACP) advises in a paper published in JAMA Internal
"Discussions about end-of-life care, especially early in the
course of a life-limiting illness, are associated with care more
consistent with patient goals and improved patient outcomes,
including longer survival rates and better quality of life," said
Dr. David Fleming, president, ACP. "This approach is also
associated with improved bereavement outcomes for family
Co-authored for ACP's High Value Care Task Force by Dr. Rachelle
Bernacki and Dr. Susan Block from the Center for Palliative Care at
Harvard Medical School, "Communication about Serious Illness Care
Goals: A Review and Synthesis of Best Practices" notes that a
consistent and large body of mostly observational research shows
that patient, physician, and system factors all contribute to
deficiencies in serious illness care communication.
The paper reviews current literature and describes best
practices in conversations about serious illness care goals. The
paper also offers practical advice for clinicians and health care
systems about developing a systematic approach to the quality and
timing of such communication to assure that each patient has a
personalized serious illness care plan.
"It is important for physicians, patients, and their families to
know that the evidence does not support the commonly-held belief
that communication about end-of-life issues increases depression,
anxiety, or loss of hope among patients," Dr. Fleming said.
Effective communication about end-of-life care may also reduce
costs. Best practices in discussing goals of care include sharing
prognostic information, eliciting decision-making preferences,
understanding fears and goals, exploring views on tradeoffs and
impaired function, and wishes for family involvement, the authors
ACP advises that communication about serious illness care goals
should come from the patient's primary clinician even when a team
of clinicians is involved with the patient's care. Key elements of
a system to help assure that every patient has a personalized
serious illness care plan include training clinicians, identifying
patients at risk of dying, preparing and educating patients,
"triggering" physicians to conduct discussions at the appropriate
time, a structured communication format for goals of care
discussions, a system to assure documentation of these discussions,
and metrics to gauge performance.
ACP supports the need for improving the approach to serious
illness and end-of-life care, as well as the system changes needed
to assure thoughtful and timely communication with patients and
their family members across all health care settings.
The most common clinical conditions relevant to the paper
include cancer, congestive heart failure, chronic obstructive
pulmonary disease, and chronic kidney disease / end stage renal
About ACP's High Value Care Task ForceACP's High Value
Care initiative is designed to help doctors and patients
understand the benefits, harms, and costs of tests and treatment
options for common clinical issues so they can pursue care together
that improves health, avoids harms, and eliminates wasteful
practices. ACP defines High Value Care as the delivery of services
providing benefits that make their harms and costs worthwhile.
ACP's High Value Care Task Force papers focus on value by
evaluating the benefits, harms, and costs of a test or
intervention. Value is not merely cost. Some expensive tests and
treatments have high value because they provide high benefit and
low harm. Conversely, some inexpensive tests or treatments have low
value because they do not provide enough benefit to justify even
their low costs and might even be harmful.
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 141,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
from health to complex illness. Follow ACP on Twitter and Facebook.