Deathly serious: Time for more talking; odds not great without it

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Emily Mongan
Emily Mongan

It's no secret that end-of-life discussions can benefit skilled nursing residents. Recent research has shown that such talks have the potential to improve residents' outcomes, help them appoint a surrogate or representative, and reduce their odds of dying in a hospital.

For all the benefits that end-of-life care talks can bring, studies have shown that a relatively low number of residents actually participate in them. Now a new study in the Journal of the American Geriatrics Society indicates that even when such talks take place, patients' preferences aren't always understood or effectively communicated.

A team of researchers from Yale University conducted interviews with 350 veterans over the age of 55, as well as separate interviews with the people the veterans had chosen as their surrogates.

The interviews found that more than 40% of the veteran-representative duos reported that the veteran had not communicated his or her wishes, completed a living will or healthcare proxy. The research also showed that patients and their surrogates disagreed about how well they had communicated about end-of-life care choices.

In total just 20% of the surrogates interviewed correctly predicted the veterans' end-of-life care preferences; that knowledge increased slightly in the pairs who reported that they communicated well.

"You can't assume advanced care planning achieves the goal of making sure the surrogate understands what the patient wants," said lead researcher Terri Fried, M.D. “Planning needs to include a facilitated discussion between the patient and the surrogate to make sure they are hearing each other and talking about things that are important to the patient.”

So what does this have to do with long-term care providers? After all, isn't the issue here between patients and their representatives? Not quite.

Fried suggests that older patients and their surrogates may need a little extra help with end-of-life care planning, be it in the form of an internet-based tool or clinician facilitator.

As Fried points out, “The jury is still out on the best way to help people,” a statement backed up by the numerous studies on the best way to approach end-of-life care discussions, and the number of seniors who still don't participate in them.

But as this most recent research shows, a bit of outside encouragement could be what's needed to help solve some of this miscommunication between patients and their surrogates. And a long-term care staff member may just be the missing piece of that puzzle.

Emily Mongan is Staff Writer at McKnight's. Follow her @emmongan.


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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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