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Start the most difficult conversation American isn’t having- the conversation about our end of life preferences

Making Better End Of Life Decisions Starts With Conversations

Two Harvard physicians are informing Americans about what awaits them at the end of life if they opt for aggressive, life-prolonging treatments. Drs. Angelo Volandes and Aretha Delight Davis are producing and distributing short videosshowing how some patients suffer from these common treatments in an effort to better inform patients about end of life care.

Videos
Image: Advance Care Planning Decisions

During their appearance on “The Diane Rehm Show,” a production of Washington D.C.’s NPR affiliate, the physicians decried the fact that though most Americans say they want to die at home, 75 percent spend their last moments in hospitals or nursing homes. Hospitalization usually means more painful, costly and futile attempts to prolong life; this type of care accounts for 30 percent of all Medicare spending.

“What we often find is that doctors use complex language to start the conversation, and we live in a visually literate society,” Volandes said. “If a picture speaks a thousand words, videos speak hundreds of thousands of words.” Too often, they noted, physicians are the ones initiating these conversations.

These videos also aim to dispel fears of awkwardness surrounding end of life conversations among families, so they will in turn become more common. “The conversation is one of the most difficult, yet one of the most important discussions you will have in your lifetime,” Davis said. Families should ask questions about concerns and fears, as well as about intervention and treatment preferences.

Their efforts have not gone unnoticed, and they pride themselves on being “the most subversive doctors in the medical field.” However, according to Davis, the U.S. is currently facing a “war on death.” She said:”If you have not translated your values, your wishes, the core of who you are into some sort of medical plan, unfortunately what I will do is often times provide marginal benefit, cause great suffering to you and your family, and frankly, only postpone your death.”

Advance Care Planning Decisions, the nonprofit organization founded by Volandes and Davis, features more than a dozen videos ranging in topic from the benefits of hospice care, CPR procedure and how feeding tubes work. Certain videos are even available in Mandarin, Tagalog and Japanese.

In 2010, Medicare paid about $55 billion on doctor and hospital bills during the last two months of patients’ lives– more than the budget for the Department of Homeland Security, according to research from the Dartmouth Institute for Health Policy. Some 20 to 30 percent of those medical expenses may have had no meaningful impact on patients’ health.