Vital Decisions Summarizes IOM “Dying in America” Report and Offers Real Time Solutions For Individuals Near the End-Of-Life

On September 17, 2014 The Institute of Medicine (IOM) released a 507 page report entitled “Dying in America: Improving Quality and Honoring Individual Preferences near End-of-Life”. The study was conducted by a 21 member committee comprised of experts in many fields of study including palliative care and hospice, ethics, clinical decision making, public policy. Their charge was to conduct a study and release a comprehensive report on the current state of dying in America and provide recommendations to improve the process and eliminate the gaps in care that exist today. The committee provided 5 recommendations which are summarized below.

1. Government health insurers, care delivery programs, and private health insurers should provide comprehensive care for people with advanced illness near the end-of-life. Care should be seamless, high quality, integrated, and patient centered. It should consider physical, emotional, social, and spiritual needs. It should be delivered by professionals with appropriate expertise and it should be consistent with the patients’ values, goals, and informed preferences.

2. Standards should be established for clinician-patient communication and advance care planning. These need to be evidence based, actionable, and measurable. The results of these conversations should be incorporated into the ongoing care plans of the patients. These care plans need to continue to be revisited as circumstances and preferences change over time.

3. Appropriate training, certification, and licensing should be established by educational institutions, credentialing bodies, health care delivery organizations, etc.

4. Quality of care should be consistent with the priorities and preferences of the patients with advanced illness towards end-of-life.

5. Fact based information around care for individuals with advanced illness at end-of-life should be provided by informed constituents including community and faith-based organizations, civic leaders, consumer groups, payers, health care delivery organizations, and other experts. These groups should encourage advance care planning and informed choices based on the individual.

The study concludes that major gaps in care exist for patients with advanced illness towards the end- of-life and that urgent attention is needed in this area. The study mentions that “often clinicians are reluctant to have honest and direct conversations with patients and families about end-of-life issues” and “the committee believes a patient centered, family oriented approach to care near end-of-life should be a high national priority”

Vital Decisions applauds the research and study published by the IOM. Since 2008 we have been providing high quality, patient centered care to advanced illness individuals that is highly consistent with the IOM’s recommendations. We firmly agree that the emotional, social, and spiritual needs of the patient and their family needs to be highly integrated into the medical care decision making process as care at this time must be of high quality and most importantly consistent with the individual’s values, goals and informed preferences.

Vital Decisions built the Living Well program around the concept that tremendous gaps in communication and shared decision making exist among individuals, their families and their physicians during end-of-life. We understand the need for high quality, ongoing communications to take place, however we also recognized that a large part of the reason this is not occurring on a regular basis is because of behavioral barriers that exist within this group. Barriers such as fear, anxiety, denial, anxiety over failing loved ones, etc. need to be removed before the patient can engage in a meaningful discussion with the stakeholders around their end-of-life priorities and preferences.

Our behaviorists work over time with patients to help them overcome these barriers catalyzing them to become more active participants in their care plan and encouraging those high quality conversations with their physician, family, and caregivers. Our program is evidence based, actionable, and measurable. It is supported by the individual works of our world-class advisory panel that includes experts with a wide array of expertise around end-of-life care.

We are currently the only organization utilizing advanced degree behaviorists and a focused behavior change model geared towards enhancing communications and shared decision making across all the stakeholders. When patients effectively identify and communicate their end-of-life wishes with their family and physicians, they tend to choose more palliative care earlier on in the disease trajectory. This self-selection has produced average savings of 20%-25% of costs during the last six months of life. Historical ROI has been approximately 4:1 for payers sponsoring our program.

Please contact Matthew Patella at mpatella@vitaldecisions.net or 201-396-0165 for additional information on how the Vital Decisions Living Well Program provides the execution capabilities to address the strategic recommendations of the study.
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