Improving the Quality of Life at the End of Life

Categories: Research.

A recurring theme within the hospice palliative care field is the lack of communication between patients and their medical team. This problem causes patients to go through painful and unnecessary medical procedures that do not prolong the life of terminally ill patients. The question that should be asked is, “why are doctors not having the necessary conversations with terminally ill patients?” Firstly, doctors are not properly trained in medical school to prepare discussions with their patients regarding end-of-life care causing some to feel awkward and ill-prepared to begin the conversation (Canadian Hospice Palliative Care Association, 2014). According to a Canadian Hospice Palliative Care Association (CHPCA) study, only 32% of Canadian GP’s feel comfortable talking about hospice palliative care independently. This statistic alone should alarm medical professionals, and educators alike. Secondly, doctors have stated that if they become required to prepare a discussion for end-of-life care, they must be compensated for their efforts. According to Dr. Robert Wah, the president of the American Medical Association, “These end-of-life discussions… take time, they take preparation, and we believe they need to be covered.” Currently, doctors are not reimbursed for these conversations, which could be a major factor for doctors not discussing end-of-life care with their patients.

According to the National Hospice Palliative Care Organization (NHPCO), 1.5-1.6 million Americans received hospice care in 2013. Over the last few years, the organization has seen an increase in individuals seeking hospice/palliative care, with many choosing home hospice as their primary medical care. Even with the increase in hospice/palliative care, only half of Medicare beneficiaries use the hospice benefit. This may be due in part to the restrictive measures put on the benefit. In order to use the benefit, a patient must first have a doctor sign off on a life expectancy of less than six months, as well as the patient must deny any life prolonging treatments, if hospice care is chosen. Richard Bernstein, MD, a professor at Icahn School of Medicine at Mount Sinai, New York, states that the life expectancy criteria is based on “the cost of the benefit,” creating a difficult position for doctors trying to diagnose a patient’s life expectancy.

These problems faced by doctors and terminally ill patients raises the question of needing more awareness for hospice/palliative care internationally. The struggles faced by patients and doctors alike need to be addressed sooner, rather than later, so that patients can properly assess and create an end-of-life medical plan.

For the complete AMA article, please visit

For more statistics from the NHPCO, please visit

For more information on the CHPCA study, please visit

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