Virtually all physicians believe talking with patients about end-of-life and advance care planning is important, but many are unsure how to discuss the topic, according to a national survey commissioned by The John A. Hartford Foundation, the California Health Care Foundation and Cambia Foundation.
The survey includes 736 primary care and specialist physicians in 50 states. Specialist physicians surveyed are oncologists, pulmonologists and cardiologists.
Here are seven findings from the survey.
1. Seventy-four of physicians surveyed report seeing many patients who could die within a year. Most (75 percent) believe they — not the patient, another physician, or other
healthcare professional — are responsible for initiating end-of -life and advance care planning conversations.
2. Still, physicians identify various barriers that get in the way. Nearly half — 46 percent — of physicians frequently or sometimes feel unsure of what to say, and only three in 10 respondents (29 percent) said their practice or health system has a formal system for assessing patients' end-of-life wishes and goals of care. Furthermore, only 29 percent of physicians surveyed report having had any formal training specifically on talking with patients and their families about end-of-life care, and 24 percent said there is no place in their EHR indicating if a patient has an advance care plan.
3. Training plays a key role in physician responses. The survey found physicians with explicit training in end-of-life conversations are more likely (46 percent) to find conversations about end-of-life care to be rewarding than those who have not (30 percent). Physicians surveyed also are unsure about what to say in these conversations "rarely or not too often" (60 percent), compared to those who have not had explicit training (52 percent).
4. The survey found physicians' concerns about these conversations come from their commitment to patients. Many physicians surveyed didn't want an advance care planning conversation to cause patients to feel the physician was "giving up" on them (48 percent) or to "give up hope" (46 percent). Similarly, the survey found, physicians value advance care planning as a way to honor patients' values and wishes (92 percent), reduce unwanted hospitalizations at the end of life (87 percent), and have patients and families feel more satisfied with their care (81 percent).
5. Ninety-five percent of physicians surveyed support a new Medicare benefit that reimburses them for having those discussions, although only 14 percent have billed Medicare for an advance care planning conversation since reimbursement began three months ago.
6. While the long-term impact of the new Medicare benefit remains unclear, 75 percent of physicians surveyed predict it will make them more likely to talk with older patients about advance care planning.