Pandemic Spurring End-of-Life Care Planning

Nearly 70% of 1,000 survey respondents indicated that talking about their wishes and values for end-of-life care was important to them, but only slightly more than half (56%) had actually held these conversations, according to a study by VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE). These numbers were up from a previous study in 2018 that found roughly a third had shared their wishes. 

The massive loss of life from the coronavirus pandemic has prompted many to consider their goals and wishes for the end-of-life. The VITAS study indicated that the COVID-19 outbreak has sparked more conversations between health care professionals and patients around their final wishes.

“The COVID-19 pandemic vividly illustrated that anyone’s health can turn on a dime, so part of caring for your family is ensuring that they know your wishes and values,” sources from VITAS told Hospice News. “One of the keys to getting people more comfortable talking about advance care planning is discussing it as part of routine care and revisiting the conversation on an ongoing basis.”

COVID-19 has claimed more than 2.87 million lives globally since its onset, according to a recent World Health Organization report.

According to VITAS, while most people say these conversations are important, they do not always take action to discuss or document their desires. The data indicates that more people have been open to talking about their wishes than prior to the pandemic. About 42% of respondents said that they hadn’t written down these wishes because they were not yet sick or dying.

The study found that lack of awareness was a leading barrier to advance care planning conversations, with 22% reporting that they didn’t know how to document their end-of-life care goals. According to VITAS, 99% of physicians believe that these conversations are important, though only 29% reported that they have received formal training in discussing end-of-life care.

“An informed patient, armed with choices and an understanding of their current health status, feels in control,” according to VITAS. “Using an approach that empathizes, informs and seeks to learn about the patient’s health care goals often results in their willingness to work with you to develop their future care plan.”

A key component of that change would be to foster end-of-life conversations among patients and families. Many hospice providers are ramping up their efforts to promote advance care planning, but breaking through public misperceptions around end-of-life and serious illness care has been a major hurdle.

Early conversations are positively associated with family decisions to limit or withdraw life-sustaining treatments, as well as fewer in-hospital deaths and unplanned admissions. They also contribute to reduction in hospital lengths of stay, higher family satisfaction with end-of-life care and greater likelihood of receiving strong opioid pain medications in the last 24 hours of life, according to a study in the March 2019 issue of the Journal of the American Medical Directors Association.

These conversations can also serve as an introduction to hospice and palliative care for patients and helping patients find the services they need earlier in the course of their illness.

“Health care professionals are uniquely positioned to help start these conversations, because more than a quarter of Americans expect them to initiate the conversation,” VITAS told Hospice News in an email. “Hospices can help empower referring clinicians by providing resources to help them talk to their patients about advance care planning. Referring physicians and partners play a crucial role in initiating the conversation about advance care planning with patients.”