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Evidence-Based Oncology April 2015
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Currently Reading
Palliative and End-of-Life Care: Issues, Challenges, and Possible Solutions in the United States
Kashyap Patel, MD; and Mary Kruczynski
Comprehensive Support for Individuals Living With Prostate Cancer and Their Caregivers Complements Palliative Care Services
Dan Klein, and Jamie Bearse
Patient, Physician, and Payer Conversations in Palliative Care: Moving Beyond Fear
Patti Forest, MD, MBA, FAAFP
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Michael D. Fratkin, MD
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Amy S. Kelley, MD, MSHS; and Diane E. Meier, MD

Palliative and End-of-Life Care: Issues, Challenges, and Possible Solutions in the United States

Kashyap Patel, MD; and Mary Kruczynski
The foundations of suitable EOLC and improvement in quality of death are rooted in physician-patient communication. Improving the overall quality of death for a multicultural society like the United States rests on awareness among healthcare providers of cultural and ethnic preferences and of beliefs related to death and dying. Educating providers about these attitudes would result in enhanced trust, confidence, and patient acceptance of appropriate EOLC. As stated previously, improved communication about advance directives, EOLC, and comfort care result in acceptance of better EOLC, improved quality of life, and reduced healthcare expenditure.

Another necessary, significant step is to remove politics from the EOLC conversation. As much as we want to respect individual freedom and autonomy, hijacking a real debate on EOLC for sheer political gain not only causes disservice to patients, but to society as a whole. This may partially explain why, despite spending hundreds of billions of dollars, our nation still lags behind many developed countries in both quantity of life and quality of death.

Finally, we want to embrace death not as a failure for a physician, but rather as a natural process that all of us will face one day. Let us no longer stigmatize death as our failure. EBO

Kashyap Patel, MD, is president of the South Carolina Oncology Society. He also serves on the board of directors of the Community Oncology Alliance, Washington DC, and is CEO of Carolina Blood and Cancer Care, Rock Hill, SC.

Mary Kruczynski is director, policy analysis, Community Oncology Alliance, Washington DC.
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2. Barnato AE, McClellan MB, Kagay CR, Garber AM. Trends in in-patient treatment intensity among Medicare beneficiaries at the end of life. Health Serv Res. 2004;39(2):363-375.

3. Sullivan AM, Lakoma MD, Block SD. The status of medical education in end-of-life care. J Gen Intern Med. 2003;18(9):685-695.

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6. Zhang B, Wright AA, Huskamp HA, et al. Health care costs in the last week of life: associations with end-of-life conversations. Arch Intern Med. 2009;169(5):480-488.

7. Zhang B, Nilsson ME, Prigerson HG. Factors important to patients’ quality of life at the end of life. Arch Intern Med. 2012;172(15):1133-1142.

8. Granek L, Tozer R, Mazzotta P, Ramjaun A, Krzyzanowska M. Nature and impact of grief over patient loss on oncologists’ personal and profes- sional lives. Arch Intern Med. 2012;172(12):964- 966.

9. The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT) [published correction appears in JAMA. 1996;275(16):1232]. JAMA. 1995;274(20):1591-1598.

10. Institute of Medicine. Dying in America. Improving quality and honoring individual preferences near the end of life. Washington, DC: National Academies Press; 2014.
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