In contrast, studies have indicated a strong patient preference to die at home. The key desires of patients and families at the end of life, along with complaints about the current system, are related to control of the process of healthcare. This next phase of process improvement is focused on the population near the end of life, and the services that can help them meet their desire to die at home. Allina s home care agency, one of the largest single-site agencies in the country, along with its affiliated hospice, was the site for this work. Its stated goal explicitly recognizes patient and family desires to participate in decision making and to avoid institutional settings at the end of life.
Many barriers exist to prevent the inclusion of advance care planning in clinical practice.
Good communication and listening skills are prerequisites for therapeutic provider-patient relationships. Overall, communication about these matters is poor and often very general in nature, avoiding details. Both physicians and patients most frequently cited the reason for lack of communication as the subject never came up. There is no reimbursement from a health plan for such discussions performed in an office setting for anyone other than a physician. Key parties to this discussion, such as family members or other loved ones, are frequently unable to attend clinic visits.