There’s no easy way to discuss end-of-life care. And there’s no easy way for patients and families to make decisions related to it. But there are advances in technology that could help providers frame the discussion to help patients and families better understand their situation and gain confidence in the choice they are making.
“I do believe that we’re really at a point that we’re starting to see data analytics and predictive modeling for individuals, especially as we start to look at population health,” says Michael L. Munger, MD, a family physician in Overland Park, Kansas, and president of the American Academy of Family Physicians. “These tools help you not only with your end-of-life discussion, but they are also going to lead to more and better utilization of palliative care services.”
Providers sometimes come to a point where they see that there aren’t many options left for a patient to experience clinical improvement or any meaningful quality of life, but with the high level of medical intervention that is possible, some patients’ families find it difficult to accept. Other times, providers may want to continue with interventions at the request of families, without a clear picture of how those actions might actually help patients.
In these cases, predictive analytics may prove useful. It can offer providers risk stratification scores based on a patient’s conditions, medications, hospitalizations, and age. That information can then be shared with families and patients. “To me that’s almost like the next frontier,” Munger says. “It allows everyone to really focus on what they want and what is reasonable. It addresses the question of how do you want to live the rest of your life in the best manner and what’s important to you. Hopefully we can shift the conversation from having to do everything possible to one of having great quality of life.”
Predictive modeling can be used even when end-of-life isn’t imminent. For example, in primary care offices providers can discuss end-of-life care plans with patients using data about their age, comorbidities, functional level, and more. “It’s then a lot easier when you’re sitting down with mom and adult children to say, ‘This is what we see based on all of the previous information and studies together,” says Munger.
These discussions, while difficult, can result in patients living their final years with the best quality of life with fewer hospitalizations, he says. “There is peer-reviewed research that shows that if you have that true advanced care planning earlier, it leads to better care and much higher patient satisfaction. Families no longer feel like they are making the decision to withdraw care,” Munger says. “You have to have these discussions sooner. You can’t wait until it’s time; we have to have it ahead of time.”