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    Poll Reveals Challenges of Providing End-of-Life Care

    Doctors Overwhelmingly Support Palliative Care, but Some Patients Have Concerns

    Survey Results continued...

    In a panel discussion that followed presentation of the poll results, experts pointed out that the two goals need not be mutually exclusive.

    "Palliative care is a medical subspecialty that's appropriate for all patients with serious illness -- regardless of diagnosis or the stage of their disease -- that focuses on symptom management and pain control, but also the stress of serious illness and quality of life for patients and their families," says Amy S. Kelley, MD, assistant professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York City.

    Patients' Concerns About Palliative Care

    Poll results reveal that palliative care is not always accepted by patients.

    Nearly 60% of doctors report that they've had patients or their family members reject their recommendations for end-of-life treatment.

    Patient reactions can shape a doctor's willingness to make palliative care part of their practice.

    "It doesn't take that many patients to react badly for you to have kind of an outsized impression as a doctor that this is a fraught territory, a territory with a lot of land mines in it," Brownstein says.

    Paying for End-of-Life Care

    Patients and doctors also appear to differ on how health care dollars should be spent at life's end.

    The cost of end-of-life care in the U.S. is substantial.

    Studies have shown that roughly a quarter of Medicare's budget goes to patients in the last year of their lives, a share that hasn't changed substantially in at least three decades.

    Nearly 80% of doctors surveyed say too much money is spent trying to extend the lives of seriously ill patients.

    But only 37% of Americans agreed with that statement in the poll, and more than half said the system has the responsibility to spend whatever it takes to prolong life.

    Brownstein says people don't seem to like the idea that money should be under discussion at such a personal and profound moment.

    "I really think the fault line here is to the extent any of this kind of care is seen as increasing options for patients and their families, people really welcome it," Brownstein says. "If it is seen as an agenda to save money for the government or insurance companies, they really recoil from it. And that is a really bright line in how people react."

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