PHILADELPHIA - Although the public and private sectors are currently engaged in an unprecedented array of efforts to improve end-of-life care, too many of these programs are not evidence-based, according to a scholar from the Perelman School of Medicine at the University of Pennsylvania. Writing in the New England Journal of Medicine , Scott Halpern, MD, PhD, associate professor of Medicine, Epidemiology, and Medical Ethics and Health Policy, says that despite recent federal decisions that signal a renewed interest in improving end-of-life care, investigators and research sponsors must be more involved to "identify, develop and rigorously test interventions so they can offer guidance" on implementing programs that work among the terminally ill.
In his commentary, Halpern says if end-of-life care policies were approached in the same way the United States adopts new drug policies, the long-term interests of patients, health systems, insurers, and the government would be better served.
"In July 2015, the Centers for Medicare and Medicaid Services (CMS) announced its plans to reimburse physicians for engaging their patients in advance care planning discussions," Halpern writes. Although he notes that the decision was based on the "valid premise" that communication among all patients and clinicians is an important way to improve the quality of end-of-life care, Halpern says the problem is that "no current policy or practice designed to improve care... is backed by a fraction of the evidence" required for drug approvals in the United States.
Halpern suggests four developments that he calls "attainable," and describes how achieving these goals will help achieve evidenced-based end-of life-care:
Though encouraged by the enthusiasm of federal organization and their willingness to intervene in end-of-life care programs, Halpern says the central challenge today is to "avoid complacency regarding plausibly useful but non-evidence-based initiatives. Researchers, research sponsors, and large insurers, employers and health systems can work together to advance knowledge about what works best for whom."
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New England Journal of Medicine