A Roadmap for Success: Transforming Advanced Illness Care in America
See Appendix A for a brief history of advanced illness care and the hospice movement.
The Current State of Play As discussed in Appendix A, the Institute of Medicine of the National Academy of Sciences issued a landmark report in 1997 titled, “Approaching Death: Improving Care at the End of Life.” In another major contribution to the field, the Institute issued a follow-up report in 2014, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,”5 prepared by an expert committee co-chaired by Philip A. Pizzo, MD, the former Dean of the Stanford University School of Medicine, and David A. Walker, former U.S. Comptroller General of the United States. This new report calls for changes in policy, financing and clinical care and issues a call for national efforts to improve comprehensive and compassionate care, clinician-patient communication, advance care planning, revised payment systems, quality standards, professional training and enhanced public education, among other things. It will have a positive effect on the reform of advanced illness care in the U.S. It is important to stress what reformed advanced illness care is not. It is not about rationing care. It is not about callously “pulling the plug on grandma,” as some have charged. It is not about death panels deciding who will live and who will die. It’s about changing a care system that is uncoordinated and chaotic. Research shows that when people with advanced illness get the information they want and need, they tend to choose less aggressive treatment and more comfort-focused care and professional and family support. Sometimes, more treatment is chosen and the health system should be supportive of such decisions that honor the patient’s wishes. A physician told the story of his treating an elderly woman on a ventilator. Every week, he called the woman’s daughter and said, “Your mother is not going to get better. Are you sure this is what you want for her?” And each week the daughter responded, “Please 10