Expert Commentary

The Impact of US Healthcare Policy on Advance Care Planning Part I

Andrew Epstein, MD

Palliative Medicine
Mount Sinai Medical Center
New York, New York

Advance healthcare planning allows patients with life-threatening illnesses, such as cancer, to plan their future medical care collaboratively with caregivers and healthcare providers. This process has received recent attention on both national and state levels. Most notably, under Pres. Obama’s Patient Protection and Affordable Care Act of March 2010, physicians can now be reimbursed for providing voluntary consultations related to advance care planning for their patients with declining health. Further, since January 2011, New York State healthcare practitioners are required to inform patients with less than six month life expectancies about their disease process and end-of-life care options. Although physicians may be reluctant to initiate these difficult discussions for the fear of inflicting psychological harm on patients, recent research suggests that such communication is necessary to prevent adverse outcomes. Also, recent studies, mostly conducted in cancer patients, support the benefits of palliative care in improving quality of life and prolonging survival.

 

References

  1. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19;363(8):733-42.
  2. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008 Oct 8;300(14):1665-73.
  3. Dow LA, Matsuyama RK, Ramakrishnan V, Kuhn L, Lamont EB, Lyckholm L, Smith TJ. Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives. J Clin Oncol. 2010 Jan 10;28(2):299-304. Epub 2009 Nov 23.
  4. Smith TJ, Dow LA, Virago EA, Khatcheressian J, Matsuyama R, Lyckholm LJ. A pilot trial of decision aids to give truthful prognostic and treatment information to chemotherapy patients with advanced cancer. J Support Oncol. 2011Mar-Apr;9(2):79-86.
     
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