Institute of Medicine Says End-of-Life Care Must Be National Priority
A person-centered, family-oriented approach honoring individual preferences and promoting quality of life through the end of life should be a national priority, says a new report from the National Academies’ Institute of Medicine.
The authors of Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life say health care sector workers, including clinicians, clergy, caregivers and support staff have a professional commitment and responsibility to provide high quality care for people nearing the end of life. They add that health system managers, payers and policymakers also have a “responsibility to ensure that end-of-life care is compassionate, affordable, sustainable and of the best quality possible.”
The IOM calls it a “pressing need” to improve end of life care, highlighting the increasing number of older Americans with some combination of frailty, physical and cognitive disabilities, chronic illness and functional limitations.
“The U.S. also is quickly become more culturally diverse, heightening the need for responsive, patient-centered care,” the report says.
The authors see the nation’s health care system as “increasingly burdened” by factors affecting the delivery of quality care near the end of life, including barriers in access to care that disadvantage certain groups, inadequate numbers of palliative care specialists, fragmented care delivery system spurred by “perverse financial incentives” and a mismatch between services needed and services obtainable.
According to the IOM committee that wrote the report, the advance care planning process can begin at any age or state or health and should center on frequent conversations with family members and care providers. Professional societies and other organizations establishing quality standards should develop standards for clinician-patient communication and advance care planning, it says.
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