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End-of-life care conversations with physicians still rare

One New York-based physicians' organization is starting to have discussions with all of its adult patients regarding end-of-life care after the director's father died without being able to speak or move. Medicare has also introduced a new policy known as advanced care planning that pays nurse practitioners, physician assistants and doctors $86 for a session of up to half an hour discussing end-of-life wishes. However, many physicians say that this is unlikely to significantly increase the number of doctors willing to have this conversation with their patients.

One issue is that doctors are simply not trained to do so. The New York organization uses a booklet that helps medical professionals work through various points such as whether the patient wants end-of-life care and who they would choose to make decisions regarding their medical care. Some medical schools are also training doctors now in how to conduct end-of-life conversations.

However, other physicians say that they are simply not comfortable with the conversation. One says he regrets not discussing end-of-life care with one of his patients after he felt the patient's suffering was unnecessarily prolonged, but he said that he would still not make it a regular part of his practice.

Discussing end-of-life care is also one aspect of estate planning. Even if people do not manage to have this conversation with their physician, they can include the necessary documentation in their estate plan as well as talking about it with their family and attorney. Documentation that says what kinds of methods, if any, people would like to have used to prolong their life can be created as can documentation that chooses someone to make medical decisions on the person's behalf, such as a healthcare power of attorney.

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