IOM Recommends Communication, Focus on Patient in End-of-Life Care

“Broad improvements to end-of-life care are within reach,” according to a report by the Institute of Medicine (IOM) titled  Dying in America: Improving Quality and Honoring Individual Preferences Hear the End of Life. The report notes that such improvements could enhance the quality of life through the end of life and can help to support a more sustainable health care system.

Person-Centered, Family-Oriented Care

The report notes that transitions between health care settings near the end of life “can fragment the delivery of care and create burdens for patients and families.” Thus, the demand for family caregiving is growing to include not just personal care and household tasks, but also medical and nursing tasks, such as the management of medication. The patients’ comfort is also of the utmost importance, as the study notes that palliative care, which helps aid symptoms, pain, and stress, “is associated with a higher quality of life, including better understanding and communication, access to home care, emotional and spiritual support, well-being and dignity, care at time of death, and lighter symptom burden.” Despite the benefits of palliative care, timely referrals to such care have not been widely adopted.

Clinician-Patient Communication and Care Planning

Patients near the end of life are often unable to make their own decisions about care, and those being given acute care are receiving treatment from physicians with whom they do not have a long-standing relationship. Advance planning helps to take into consideration patients’ values, goals, and preferences. The report states that frequent clinician-patient conversations as to these preferences can “ensure that patient and family decision making is based on adequate information and understanding.

Other Improvements

The report adds that professional education, public engagement, and programs integrating health care and long-term social services have the potential to reduce hospitalizations and costs and improve patients’ quality of life. With the “rapidly increasing number of older Americans with some combination of frailty, physical and cognitive disabilities, chronic illness, and functional limitations,” and due to the cultural diversity becoming more widespread in the U.S., end-of life care can be more responsive and more patient-centered.