One of the greatest hurdles in care for serious illnesses is deciding how long to treat curatively, and when to transition to palliative and end-of-life care. Where this process begins is in conversation between a patient and their physician. Yet all too often, these conversations fail to uncover what really needs to be known in order to make the best decision for the patient. In Massachusetts, an organization called the Massachusetts Coalition for Serious Illness Care has successfully lobbied to improve physician training on how to ask more personal questions to make better decisions in end-of-life care.
Poor communication in end-of-life-care planning
According to a recent survey by the Massachusetts Coalition for Serious Illness Care, 85 percent of Massachusetts residents believe physicians and their patients should talk about end-of-life care, but only 15 percent have actually had such conversations. More troubling, only 25 percent of respondents facing serious illness reported speaking with their physician about end-of-life care.
These figures present a troubling picture for how our medical community deals with end-of-life care. Without a clear understanding of a patient’s wishes, their expectations for care, and what they want to get out of life in the final weeks and months, it is difficult to plan effectively. Hence, the Massachusetts Coalition for Serious Illness Care has made it their mission to improve communication between patients and physicians, and to train physicians when it most matters: in medical school.
New training for physicians in Massachusetts
What the new training — now offered at all four medical schools in Massachusetts — aims to accomplish is to train physicians to ask deeper, more personal questions about patients’ wants and needs, as well as their expectations for end-of-life care.
“We’ve trained all doctors to ask people, ‘Do you smoke?’” said Dr. Harris A. Berman, dean of the Tufts University School of Medicine, to the Boston Globe. “We’ve trained people to ask about sexual preference. That used to be a difficult discussion to have.”
With the changes in curriculum planned by medical schools in Massachusetts, physicians will also be trained on how to ask certain questions about end-of-life care. These questions will be more personal, and aim to uncover patients’ wants and expectations in life. The goal is to train physicians to understand their patients on a deeper level to make the best recommendations in face of a serious or life-limiting illness.
“People think having the conversation is scary,” said Maureen Bisognano, the coalition’s cochairwoman and senior fellow at the Institute for Healthcare Improvement, to the Boston Globe. “What we’re finding is, when people actually do it, there’s a sense of relief, a sense of peace that you have expressed your wishes to someone.”
Better communication means better outcomes
With the change in curriculum, the coalition hopes to improve outcomes in end-of-life care. They recognize that comfort and control are top priorities in end-of-life care, and to fulfill those needs there must be clear communication. Physicians need to know what constitutes comfort and control for their patients in order to make the best recommendations possible. The hope is that this new program will become the model for other states as well, thereby improving outcomes for patients across the country.