Taking the Lead on How the Public and Physicians View Death and Dying

Today’s guest blog comes to us from our friends at the Arizona Medical Association. Check out the blog below and let us know what you think. Working together with our partners to focus on the health issues affecting the people of our state is another way we are working toward our long-term goal of one day making Arizona the Healthiest State in the Nation!

Good end-of-life care is based on the understanding that death is inevitable, and a natural part of life. As the final stage in a person’s life, it is a uniquely important time for the dying person and their family and close friends. In Arizona, the physician community should feel comfortable engaging effectively with patients and families regarding decisions, options, and care for these patients. The Arizona Medical Association (ArMA) saw a need to better understand where Arizona stood on end-of-life care, and how we could help better the process for physicians and patients.

A Joint Task Force on End-of-life Care was established by the Arizona Medical Association and the Arizona Osteopathic Medical Association (AOMA). It was comprised of multispecialty physicians from across Arizona whose mission was to assess the state of end-of-life care in Arizona and to offer practical options to improve care for patients across our state. The task force met regularly from 2016 to 2018 and worked on the following:

  • Compilation of a comprehensive reference list
  • Testimony on a variety of topics relevant to end-of-life care
  • Surveys were conducted with both medical schools and residency programs in Arizona to assess how much time is included in the curriculum on end-of-life care issues

Following that work, a survey was disseminated and sent to physicians in our community; over 500 responses were received. The survey examined knowledge, skills, and involvement in end-of-life issues as well as desire for further education and views toward Physician Orders for Life-Sustaining Treatment (POLST) and Medical Aid in Dying (MAID).

Major Findings of Physician Survey

  1. Counseling of patients regarding end-of-life options occurs too infrequently
    1. Only 50% of the time when end-of-life was near.
    2. Routinely in only 37% of older patients.
    3. Perceived patient/family unreadiness was seen as the major deterrent to having these conversations.
    4. Physicians with training in EOL were less deterred.
  2. “Good Deaths” are encountered too infrequently
    1. A good death was defined as death expected, family present, symptoms controlled, patient’s wishes followed.
    2. Respondents reported that their patients currently experience “good deaths” less than 50% of the time.
  3. Lack of training in EOL care is a barrier
    1. Most physicians reported not having received training in EOL care.
    2. 40% indicated an interest in additional training.
    3. Those with more education found EOL more professionally satisfying and experienced “good deaths” more often.
    4. Most endorsed the need for public education.
    5. Despite the availability of Medicare approved CPT codes for end-of-life counseling, only 15% of physicians used them.
    6. Although Palliative Care has emerged as a medical specialty in the past 10 years, and is available in most hospitals, only 55% of respondents reported referring terminally ill patients or those diagnosed with serious life-limiting illnesses.
  4. POLST: most physicians are supportive and welcome additional training
  5. MAID was supported by 53% of respondents; opposed by 27%; and 20% were undecided

Moving forward: Taking the lead on how the public and physicians view death and dying

Education has since then been initiated for physicians and the general public on End-of-life Care with the plan to compile relevant statistics. The task force will work with the Arizona Hospital and Healthcare Association (AzHHA) on educational efforts through their Thoughtful Life Conversations program. Ongoing efforts will take many years to implement these findings and recommendations to help change the culture around End-of-life Care. It is humbling to see the courage, resilience, and fortitude that so many individuals show, even when facing life limiting illness and death; ArMA will continue to work with stakeholders on education and to monitor progress on this important topic.

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