Panel Discussion: Payer, Provider, and Patient Roles for Understanding the End-of-Life Care Equation: Cost vs Survival Time vs Quality of Life

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Amy Berman, BS, RN, Bruce Feinberg, DO, and Patti Forest, MD, MBA, sit on the first panel discussion at Patient-Centered Oncology Care 2015 and discuss advanced directives and end-of-life care.


Jan Berger, MD, MJ, founder of Health Intelligence Partners and editor-in-chief of The American Journal of Pharmacy Benefits moderated the first panel discussion at Patient-Centered Oncology Care 2015 in Baltimore, Maryland, on the topic of advanced directives and end-of-life care with Amy Berman, BS, RN; Bruce Feinberg, DO; and Patti Forest, MD, MBA.


Ms Berman, a patient with stage 4 cancer, noted 3 big challenges with advanced directives starting with the fact that the culture in the United States has trouble accepting the inevitability of death and the discomfort people have talking about end-of-life decisions. The final challenge is that 75% of people are unable to make some or all decisions at the end of life.

Dr Feinberg views the difficulty of getting patients to agree to palliative care as a cultural problem, as well.

“We as a culture—it’s not unique to healthcare—but we value new over old; we value now over later; we value more over less; and that value system that we have is pervasive in medicine,” he said.

However, Ms Berman disagreed with the claim that patients want more care. Instead, she said, evidence suggests that when patients actually have conversations about type of care they want, they don’t actually want more.

Dr Forest, from Blue Cross Blue Shield of North Carolina added that from the payer perspective, there is a fear of bringing up palliative care in case patients or providers think they’re just trying to save money and that they’re giving up on the patient. The best way to combat that fear or the accusations of “death panels” is through education.

“I think it’s quite clear … that not only can quality of life be improved but survival time can be improved,” she said. “It’s not about a death panel; it’s not about withholding care.”