As a result of advances in public health and the development of lifesaving medical technologies, Americans are living longer than ever. Death, when it comes, often follows a chronic or progressive illness.
Unfortunately, the care received near the end of life often does not reflect a person’s values, goals, and informed preferences. Although the majority of people say they would prefer to die at home, two-thirds of Medicare beneficiaries die elsewhere, such as a hospital’s intensive care unit. People frequently endure unwanted treatment and suffer from inadequate pain management and shortness of breath, which often puts an enormous stress on family caregivers. A fragmented medical system and a lack of communication among doctors, patients, and families may result in less than optimal patient experiences. But difficulties in the health care system may also be caused by the reluctance of patients, families, and doctors to discuss options and the alternatives to further treatment. Having these conversations early in the course of a serious illness is important, because most people who are near death are unable to communicate their wishes.
The Pew Charitable Trusts sought to improve end-of-life care by advocating for policies that help people make informed decisions about their treatment preferences, improve the documentation of these preferences, and hold health care providers accountable for honoring patient wishes and delivering high-quality care. Additionally, the project highlighted innovative ways of providing care to seriously ill people and their families as patients reach the end of their lives.