Dying in America

The Institute of Medicine (IOM) first issued a report on end-of-life care in 1997. Since that time, end-of-life care, as well as healthcare in general, has changed dramatically. The IOM convened a 21-member national committee from various disciplines to write an updated report on end-of-life care. The project was funded by an anonymous donor. The 507-page report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, was released on 9/17/14 and includes recommendations developed by the committee during the prior two years. The committee included physicians, nurses, religious leaders, geriatric specialists, insurers, and attorneys.

The IOM reported that Americans have strong views about the type of care they would like to receive at the end of life, and prefer to die at home and maintain control over healthcare decisions.

However, the report cites surveys that suggest that more than 25% of adults, including those aged 75 years and older, have given "no thought" to end-of-life care. Even fewer have written down their preferences or talked about them with family or healthcare providers. Challenges to delivering quality end-of-life care include the growing population of older people, increased cultural diversity in the U.S., barriers to accessing care among disadvantaged populations, mismatch between services that patients and families need and what they can actually obtain, growing demand that outpaces the availability of palliative care services, and a wasteful and costly healthcare system characterized by time pressures that interfere with communication and care coordination.

Quality end-of-life care needs to be consistent with patients' values, goals, and preferences. The IOM proposes a model for advanced-care planning that would require overhauling and restructuring Medicare, Medicaid, and other health plans. End-of-life care also can be improved via delivery of patient-centered care; frequent evaluation of the patient's physical, emotional, social, and spiritual well-being; management of pain and emotional distress; referral to hospice or palliative care according to patient needs and desires; and frequent updates to the care plan and access to services in response to the changing needs of the patient and family