September 25, 2014

IOM Provides Support that Focus is Needed on Advance Care Planning

Many studies have been done demonstrating that many individuals have not talked to providers or loved ones about end-of-life care.  However, studies also demonstrate that for individuals who discuss their wishes for decisions to be made at the end-of-life, the individual experiences an increased quality of life and both the individual and family have greater peace and satisfaction.  Despite the advent and push for completion of advance directives most individuals do not discuss their wishes.

The importance of discussing end-of-life preferences has once again been addressed, this time by the Institute of Medicine (IOM).  The Institute of Medicine is an independent, not-for-profit organization that is an arm of the National Academy of Sciences, which commissions studies and produces reports on healthcare issues.  The IOM released a report earlier this month, Dying in America: Improving Quality of Life and Honoring Individual Preferences Near the End of Life, which speaks to the “pressing need to improve end-of-life care.”  Link to the Report Found Here

The Report calls for reform and briefly addresses the issues facing the healthcare system.  The IOM report identified several key findings for improvement including the following:

  • More discussion about palliative care, which has been shown to improve quality of life, needs to occur
  • Clinicians should be reimbursed for conversations about end-of-life treatment and quality standards should be developed for clinician-patient communication and advance care planning;
  • More education is needed with appropriate provider training, certification and licensure to strengthen palliative care knowledge and skills of all clinicians;
  • All insurers should integrate the financing of medical and social services to support quality care consistent with patients’ values and preferences; and
  • Fact-based public education and engagement are needed to “normalize” conversations and encourage advance care planning and shared, informed medical decision-making

Based on these findings, the IOM Report made specific recommendations with regard to (1) delivery of care, (2) clinician-patient communication and advance care planning, (3) professional education and development, and (4) policies and payment systems.  Summary Found Here.  The IOM also addressed key components that must be addressed with the education and delivery of healthcare at the end of life. Proposal Found Here.

Key focus by the IOM is on the need to educate both providers and individuals about palliative care and equip providers to provide better access for patients to palliative care.  New York is already ahead on this with the requirements under the Palliative Care Information Act and Palliative Care Access Act. Information Here.  The Report also recommends implementation of Physicians Orders for Life Sustaining Treatment, and again we in New York have already started with this with the MOLST (Medical Orders for Life Sustaining Treatment).

Additionally, an important component of the Report is the focus on honoring end of life preferences.  People should not be concerned about this report and/or fear that this report recommends limiting aggressive treatment –it does not.  Rather, the report commits to the finding that individuals, who have discussions about end of life care, experience a better quality of life and are more content because their choices, whatever they may be, will be honored. As demonstrated by the IOM in this Report and numerous other studies, reform is needed and both individuals and physicians should have conversations with each other regarding preferences that patients may have for end of life decision-making.

This article was written by Danielle Holley.  She can be reached by calling (518) 462-5601 or by email at