Americans by and large say that when their time comes they want to die at home, in the company of family and as free from pain as possible. Instead, many Americans at the end of their lives receive treatments that they don't want, that will not help them, and that only make them uncomfortable. According to the Institute of Medicine, this is happening because doctors have a hard time discussing the end of life with their patients.
The IOM, a nonprofit and nongovernmental organization, is recommending changes in the healthcare system that would allow patients to choose their care at the end of their lives rather than letting doctors decide on it or relying on circumstances to dictate what occurs. However, for this to happen, doctors will have to learn to talk with their patients about the end of life and to listen to them.
Few medical schools train doctors on how to discuss these issues with patients. Most hospitals and many doctors will pursue aggressive care unless a patient has very specific advance directives stating otherwise.
Some programs are helping start the conversation. One such program is VitalTalk, which trains doctors in how to discuss these issues. This training includes how to find out what the patient's goals are and how to talk about issues such as whether to stop cancer treatments or insert a feeding tube or ventilator. Doctors need to learn how to acknowledge a patient's emotions and ask what is important to them. With discussion, the care at the end of life can be what the patient and the patient's family want.
VitalTalk has created videos that show families what their options are and what those options involve. Visual representations of treatment may lead to different decisions that a written description would. The VitalTalk videos are being used around the country, but a study is underway in Hawaii to see how well they work at helping people make decisions on end-of-life care. The videos are being used in every hospital in the state as well as in other health facilities.
The IOM has "Conversation Resources" at http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life/the-conversation. They have more information on end-of-life care at http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx.