Dr. Leon Kraybill

Dr. Leon Kraybill, medical director at Luther Acres in Lititz, created a quilt for the nursing center's Walk of Honor.

THE ISSUE

According to a national survey — “Conversation Stopper: What’s Preventing Physicians From Talking With Patients About End-of-Life and Advance Care Planning?” — conducted by The John A. Hartford Foundation, California Health Care Foundation and Cambia Health Foundation, nearly half of physicians say they feel unsure of what to say when talking about advance care planning with their patients. Yet, the report states, virtually all doctors who see Medicare patients consider end-of-life planning important.

Every family has its share of uncomfortable topics at the dinner table. Death is just as awkward for some as politics, religion or sex is for others.

We agree those topics are sometimes better avoided. Disagreements can fracture a family by the time you put down your fork. But in order to avoid deeper disagreement and separation, an end-of-life planning conversation is necessary.

Death is scary. The mere thought of losing a loved one is heart-wrenching. But that one uncomfortable conversation may avoid awkward conversations down the road.

If the time comes to choose between an expensive, possibly life-saving surgery and voluntary death, the decision should be based on the patient’s wishes. If the patient is incapable of making that decision, the responsibility is carried over to family. That sudden, tremendous weight can fracture a family. Without any prior input from the patient, it’s an incredibly difficult choice.

That’s why we join the Pennsylvania Council on Aging in calling for all adults to consider formulating their advance health care directives. This includes a durable power of attorney and living will.

These documents provide health care instructions, specific goals and recommendations regarding treatment. They also designate a health care agent who will make health and personal care decisions on the patient’s behalf.

These two forms will assure the patient’s wishes are being followed and provide relief to family members who may have disagreed over whether this or that treatment — or none at all — was best.

The medical field is complex. So it’s understandable for adults to be overwhelmed when dictating treatment. Doctors, therefore, have an integral role in end-of-life planning.

Yet the “Conversation Stopper” survey, which polled 736 physicians who see patients 65 and older, shows that doctors have various barriers that get in the way of these discussions.

  • Nearly three-fourths of respondents say that their practice or health care system does not have a formal system for assessing patients’ end-of-life goals.
  • Twenty-nine percent report having had any formal training on having these conversations with patients and their families.
  • Nearly one-fourth say that their electronic health records don’t show whether a patient has an advance care plan. For those who do, about half can actually access the plan’s contents.
  • Many doctors avoid end-of-life discussions so their patients don’t feel that the doctors have given up (48 percent) or lost hope (46 percent).

“Part of it has been that the medical field has sometimes viewed death as a failure,” Dr. Leon Kraybill, chief of geriatrics for Lancaster General Health, told LNP. “I haven’t met any patients who lived forever yet. Death is a part of life. We can push back, but there comes a time when we can’t do any more. We need to be comfortable with that.”

Indeed, we do. And we’re pleased that steps are being taken.

In January, Medicare began reimbursing doctors and other medical professionals for consultations regarding end-of-life treatment. With actions such as this, we can start to remove the stigma attached to death.

We’re also pleased the Lancaster County community has made efforts to educate doctors and patients on advance care planning.

Kraybill said most young doctors are educated on conducting end-of-life discussions. The hospital has eight employees trained in Gunderson Health’s Respecting Choices, one of the most highly touted programs in the nation.

LGH has recently held several seminars to help patients better understand the need to discuss death preparations early and often.

We urge medical professionals to embrace these tough discussions, and we urge patients not to let fear get in the way of preparing for the future.

Be your own advocate. You deserve it.

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