Tuesday, September 30, 2014

Live Chat on Dying In America: The IOM report

by Meredith MacMartin


The Institute of Medicine recently released “Dying in America”, a report on end of life care in America. As reported in Pallimed earlier this month, this report takes a comprehensive look at the state of how we care for dying patients in this country. The committee assessed the current state of affairs and made recommendations for improvements in the following areas:
  • Delivery of person-centered, family-oriented care
  • Clinician-patient communication and advance care planning
  • Professional education and development
  • Policies and payment systems
  • Public education and engagement
The report itself is long (and I confess I have not yet waded through it in its entirety), but there is a nice summary document here outlining the key findings and recommendations. I’m particularly interested in the sections addressing professional education and development and public education and engagement, as it seems to me that these two domains hold the greatest promise for effective real and durable change in how we care for patients at the end of life. Consider these recommendations, excerpted from the above linked document:
  • All clinicians across disciplines and specialties who care for people with advanced serious illness should be competent in basic palliative care, including communication skills, interprofessional collaboration, and symptom management
  • Accrediting organizations, such as the Accreditation Council on Graduate Medical Education, should require palliative care education and clinical experience in programs for all specialties responsible for managing advanced serious illness (including primary care clinicians)
  • Certifying bodies, such as the medical, nursing, and social work specialty boards, and health systems, should require knowledge, skills, and competency in palliative care
If nursing and medical schools and residency programs don’t include required education in “primary” palliative care, if end of life care remains almost entirely excluded from medical licensing exams, and if interprofessional teams are not part of a learner’s daily environment, it does not seem to me that any amount of mandates or requirements will get real traction. Similarly, if we don’t help the general public understand the personal and family impact of advance care planning, not only will they suffer from the lack of it, but they won’t ask their nurses, physicians, and hospitals to help them with it, thus missing another opportunity to apply pressure to change.

Let’s talk about what your professional society already requires (or doesn’t). Let’s talk about how your hospital/office/agency is reaching out to the public, and how we can coordinate our efforts. Let’s talk about reaching past silos and joining forces to use the momentum of this report to take palliative care to every patient and family who needs it.

What: #hpm chat on Twitter
When: Wed 10/1/2014 - 6p PT / 9p ET
Host: Dr. Meredith MacMartin

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We will be posting the transcript and analytics here after the chat takes place. Chat Transcript and Chat Analytics courtesy of @Symplur

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