Can the United States Buy Better Advance Care Planning?
Authors: Scott D. Halpern, Ezekiel J. Emanuel
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions3 February 2015Can the United States Buy Better Advance Care Planning?Scott D. Halpern, MD, PhD and Ezekiel J. Emanuel, MD, PhDScott D. Halpern, MD, PhDFrom the Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author and Ezekiel J. Emanuel, MD, PhDFrom the Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2476 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Since the early 1980s, the delivery of care near the end of life in the United States has changed dramatically—and improved—often without much notice. The rights of persons to refuse all types of medical interventions are well-established and no longer litigated. Pain is now the fifth vital sign. Specialized palliative care consultative services are available in most U.S. hospitals (1). Increasing numbers of persons in the United States die while receiving hospice care, including 60% of those who have died of cancer (2). And new initiatives are increasingly prompting clinicians and patients to engage in advance care planning, such as ...References1. American Hospital Association. American Hospital Association Annual Hospital Surveys for FY 2000 to 2010. Accessed at www.hpoe.org/resources/hpoehretaha-guides/1148 on 19 November 2014. Google Scholar2. Teno JM, Gozalo PL, Bynum JP, Leland NE, Miller SC, Morden NE, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309:470-7. [PMID: 23385273] doi:10.1001/jama.2012.207624 CrossrefMedlineGoogle Scholar3. Halpern SD, Loewenstein G, Volpp KG, Cooney E, Vranas K, Quill CM, et al. Default options in advance directives influence how patients set goals for end-of-life care. Health Aff (Millwood). 2013;32:408-17. [PMID: 23381535] doi:10.1377/hlthaff.2012.0895 CrossrefMedlineGoogle Scholar4. Kwok AC, Semel ME, Lipsitz SR, Bader AM, Barnato AE, Gawande AA, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet. 2011;378:1408-13. [PMID: 21982520] doi:10.1016/S0140-6736(11)61268-3 CrossrefMedlineGoogle Scholar5. Riley GF, Lubitz JD. Long-term trends in Medicare payments in the last year of life. Health Serv Res. 2010;45:565-76. [PMID: 20148984] doi:10.1111/j.1475-6773.2010.01082.x CrossrefMedlineGoogle Scholar6. Personalize Your Care Act of 2013, H.R. 1173, 113th Cong. (1st Sess. 2013). Google Scholar7. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167:453-60. [PMID: 17353492] CrossrefMedlineGoogle Scholar8. Quest T, Emanuel L, Gisondi M, Engel K, Osgood K. Impact of the education in palliative and end-of-life care project on emergency medicine education and practice. J Pain Symptom Manage. 2010;39:334-5. CrossrefGoogle Scholar9. Medicare Choices Empowerment and Protection Act, S. 2240, 113th Cong. (2nd Sess. 2014). Google Scholar10. May P, Normand C, Morrison RS. Economic impact of hospital inpatient palliative care consultation: review of current evidence and directions for future research. J Palliat Med. 2014;17:1054-63. [PMID: 24984168] doi:10.1089/jpm.2013.0594 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.Grant Support: Dr. Halpern was supported by a Greenwall Foundation Faculty Scholar Award in Bioethics.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2476.Corresponding Author: Scott D. Halpern, MD, PhD, University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; e-mail, [email protected]upenn.edu.Current Author Addresses: Dr. Halpern: University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.Dr. Emanuel: Department of Medical Ethics and Health Policy, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA 19104.Author Contributions: Conception and design: S.D. Halpern, E.J. Emanuel.Drafting of the article: S.D. Halpern, E.J. Emanuel.Critical revision of the article for important intellectual content: S.D. Halpern, E.J. Emanuel.Final approval of the article: S.D. Halpern, E.J. Emanuel.Administrative, technical, or logistic support: S.D. Halpern.Collection and assembly of data: E.J. Emanuel.This article was published online first at www.annals.org on 9 December 2014. 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Meghani, PhD, MBE, RNCelebrating the ACP Centennial: From the Annals ArchiveDeborah Cotton, MD, MPH, Deputy EditorLegal Aspects of Oncology Care for Dying Patients 3 February 2015Volume 162, Issue 3Page: 224-225KeywordsBioethicsCritical careHospitalizationsMedicareMotivationPalliative carePatient advocacyPatientsVentilatorsVital signs ePublished: 3 February 2015 Issue Published: 3 February 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...