Survey: Massachusetts physicians, patients fail to prepare for end-of-life care

Massachusetts physicians and patients often fail to prepare for end-of-life medical care, according to a new statewide survey by the Massachusetts Coalition for Serious Illness Care.

The survey, of a representative group of 1,851 Massachusetts residents between March 8 and April 3, was commissioned by Blue Cross Blue Shield of Massachusetts and conducted by the research firm SSRS and the University of Massachusetts Medical School, based in Worcester.

The survey found:

  • Eighty-five percent of Massachusetts residents believe physicians and their patients should talk about end-of-life care. However, only 15 percent have actually had such conversations.
  • Even respondents facing serious illness are reluctant to plan ahead for end-of-life care. Only 25 percent of respondents facing such afflictions reported talking with their physician about end-of-life care.
  • Although the majority of people will eventually encounter medical situations in which they are unable to make decisions for themselves, almost half of the population (46 percent), including most men, people of color and those without college education, have not discussed their wishes for serious illness care with others. Most respondents (55 percent) have not named a healthcare agent (or proxy) to make such decisions.

The survey also highlights reasons why those conversations don't occur, The Boston Globe reports.

According to the report, large majorities of respondents weren't sick and didn't think they needed to talk with their physicians about end-of-life preferences, to designate a healthcare representative, or to talk to someone other than a healthcare provider. Many expressed confidence that family members and healthcare providers would know what's best.

Additionally, the survey found there is work to be done when it comes to end-of-life care. One-third of Massachusetts residents who had a loved one die in the past year said patient preferences were not fully followed. And one-fifth described the end-of-life care they witnessed as only fair or poor.

There was some good news, though. Of respondents who had named a healthcare agent, 85 percent talked to their agent about their wishes if faced with serious illness.

Overall, Atul Gawande, MD, co-chairman of the coalition, executive director of Ariadne Labs, a joint center of Boston-based Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, and author of the New York Times bestseller, Being Mortal: Medicine and What Matters in the End, called the findings "a wake-up call for all of us, clinicians and patients alike."

"People have priorities in their lives besides just living longer," he said. "They have goals and aims for the quality of their life, too. This survey shines a light on the need to ask people about what those priorities are — and then to ensure that they are honored," he said in a prepared statement.

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