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Doctors Don't Ask About End-of-Life Plans, Study Finds
Date:4/2/2013

By Steven Reinberg
HealthDay Reporter

MONDAY, April 1 (HealthDay News) -- There is a lack of communication between doctors and their elderly patients about end-of-life plans, a new Canadian study reveals.

Medical charts documented such plans for only about 30 percent of those who had them, the investigators found.

"These sick, elderly patients on acute care hospital wards have thought about the kind of treatments that they would, or would not, want in the final days, have discussed it with family, and can clearly articulate a preference," said lead researcher Dr. Daren Heyland, scientific director of the Clinical Evaluation Research Unit at Kingston General Hospital in Ontario.

Yet, there has been little meaningful conversation with any member of the health care team, and inadequate documentation as well, Heyland added.

"As a consequence, the elicited preferences of treatments at the end of life only agreed with the order in the medical chart 30 percent of the time. The majority of the disagreement was that patients were saying 'keep me comfortable' and the medical record was saying they were 'for full resuscitation,'" he said.

This lack of engagement of health care professionals in having end-of-life conversations with their patients is not just a problem in Canada, but also in the United States, an expert said.

"I wish I could tell you I was surprised," said Dr. R. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine and director of the National Palliative Care Research Center.

"This has been a recurring problem in health care for many years," Morrison added.

The report was published April 1 in the online edition of JAMA Internal Medicine.

What the difference between the medical record and the expressed preferences of the family means is a crucial one, Heyland said.

"Patients will likely undergo intensification of care at the en
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