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Discussing goals of care with patients facing serious illness is essential to ensuring that the care they receive is compassionate and aligns with their goals and wishes. Unfortunately, these conversations don’t happen enough.  A Kaiser Family Foundation poll found that almost 90 percent of U.S. adults felt that talking with their doctors about their preferred care wishes is important, but only 17 percent reported actually having such a discussion.

While end-of-life care is costly – the cost for care provided to elderly adults near the end of life accounts for about 25 percent of total Medicare spending – much of the care may not align with patients’ wishes. In a 2017 KFF survey, 71 percent of those surveyed indicated that end-of-life care should help people die without pain, discomfort and stress. Over half of the respondents rated the U.S. healthcare system as “fair” or “poor” at providing end-of-life care.

In a 2017 study published in the Journal of Palliative Medicine, one in eight respondents stated that the care provided to a loved one in the last months of life was inconsistent with their wishes. This “inconsistent care” correlated with worse ratings of quality, pain management and communication with clinicians.

Advance care planning can happen at any time along a patient’s journey. These discussions should include sharing information about how to reduce pain, discomfort and stress when receiving care for a serious, life-limiting condition.

Many patients do not understand how palliative and/or hospice care may help; in fact, they may not have even heard of palliative care. It can be easy to confuse these two types of comfort care. It is important for clinicians to be well-versed in the similarities and differences, so they can better inform patients about their options.

Understanding Palliative Care

• Definition: Palliative care is medical care that is focused on relieving the symptoms associated with a chronic or life-threatening illness. It can be offered along with curative treatments at any stage of illness to provide comfort and support. It also includes guidance making important medical decisions and assistance with coordination of care.
• Goal: The goal of palliative care is to improve the overall quality of life for a patient suffering from a medical condition. It is designed to support patients physically, emotionally and spiritually, as well as their families and caregivers.
• Eligibility: To receive palliative care, a patient only needs to request a palliative care referral from their physician at any stage of illness.
• Care team: The palliative care team is an interdisciplinary team that includes a doctor, nurse practitioner and/or nurses who specialize in palliative care, as well as other healthcare professionals such as pharmacists, social workers, therapists, chaplains and counselors. The patient’s physician may also provide some of the care.
• Care location: Palliative care is usually provided in a healthcare facility where the patient is being treated for their illness. Typically, the care is provided in a hospital, but patients can also receive it at a nursing home, ambulatory practice, assisted living facility or their home.
• Insurance coverage: Many health insurance plans, including Medicare Part B and Medicaid, cover some types of palliative care, but there may be out-of-pocket costs for treatments and medications that are not covered. The amount of coverage varies by plan.

Understanding Hospice Care

• Definition: Hospice care is a type of palliative care that focuses on providing end-of-life care and comfort, physically, emotionally and socially, for patients with a terminal illness.
• Goal: The goal of hospice care is help patients feel better and improve the quality of the life they have remaining. It also provides support for patients’ families and caregivers.
• Eligibility: To receive hospice care, two physicians must certify that the patient is terminally ill with six-months or less to live if the disease follows its normal course.
• Care team: The hospice care team is an interdisciplinary team that specializes in hospice care, similar to the palliative care team. For in-home hospice care, a family member is usually the main caregiver, but gets assistance from healthcare specialists who are on call 24 hours a day.
• Care location: Hospice care is usually delivered at home or a home-like setting, such as a hospice residence, nursing home or assisted living facility. It can also be provided in a hospital.
• Insurance coverage: Medicare, Medicaid and most private insurance plans cover hospice care for eligible beneficiaries. Medicare coverage for hospice includes pharmaceuticals, medical equipment, 24/7 access to care, nursing, social services, chaplain visits and grief support following death.

Many people die in healthcare facilities receiving care that is not consistent with their wishes. To avoid this from occurring, patients and families need to understand what their end-of-life care options and state their preferences through advance care planning.

Learn how you can engage your patients in advance care planning with video-based patient decision aids that are easy-to-understand, values-neutral, and evidence-based by contacting ACP Decisions today!

Other articles you may be interested in:

10 Ways Video Decision Aids Support the Care of Seriously Ill Populations

Getting the Conversation Started: Tips for Clinicians

Advance Care Planning Guide Part 1: Glossary of Terms

Advance Care Planning Guide Part 2: List of Resources

Implementing an ACP Program that Reduces Costs Without Compromising Care

 

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