1. Gould, Kathleen Ahern PhD, MSN, RN

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This month, we are sharing reviews from a variety of media sources that address topics vital to patients, families, and providers: How will we manage the last years of life? This issue is saturating professional and public media formats, public policy centers, academic institutions, hospitals and every type of care facility.


Dying in America is a topic addressed by the Institute of Medicine in a traditional hardcover text, PDFs, online, and webinar format. The discussion continues on social media, live conference format, and in our health care curriculums.


Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press; 2015.

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This Institute of Medicine (IOM) report was released on September 17, 2014. It is available in hardcover textbook format and digital formats. Individuals may download a free PDF or read it online at no charge.


The report reminds us that everyone has a stake in improving care for people nearing the end of life. For patients and their families, that stake is immediate and personal, and for providers, it is our professional responsibility. It is a shared commitment; as providers, families, and patients search for end-of-life care, we must join them to provide care that is focused on quality with outcomes that support living the best life in the time remaining.


This IOM report, true to IOM form, is a call to action for all Americans. It challenges everyone to begin talking to our loved ones about what kinds of care and services may be needed as time becomes limited or health declines.


The report details advances in medicine and technology that have extended lives; however, it reminds us that there are several "collateral" effects, such as frustration among providers as they try to meet the complex needs of patients, yet their training has not prepared them to confront this issue! In addition, our health care system is spending tremendous amounts of money on care that may not benefit patients and be potential be harmful, and unwelcome.


I found that 1 of the most compelling chapters, entitled "The Delivery of Person-Centered, Family-Oriented End-of-Life Care," forces us to confront some inconvenient truths. It reads,


"For most people, death does not come suddenly. Instead, dying is an inevitable result of one or more diseases that must be managed carefully and compassionately over weeks, months, or even years, through many ups and downs."


Our current health care system and health care education do not teach us to manage this natural process well, even though there is sufficient evidence that indicates that palliative methods often offer improved quality of life and, in some cases, improved longevity.


The full report offers graphics in multiple languages in both PDF and HTML formats illustrating core components of quality end-of-life care, key findings, recommendations and introductory slides, recordings, and webinar materials. This is a sentinel paper that will guide health care providers as we seek to discover better ways to support our aging population.


The report introduces The Conversation Project, which works in collaboration with the Institute for Healthcare Improvement, a nonprofit organization working to improve health care internationally.



The IOM is reaching out to health care providers and the public with a message that will encourage everyone to have a conversation with your loved ones and care providers while they are healthy.

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This YouTube video may represent the most important 33 seconds you can share with someone you love, someone you work with, or someone you live with.


The IOM report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life indicates that many people are unable to make their own decisions about care when they are nearing the end of life for a variety of reasons, many unforeseen.


However, sudden illness, injury, or changes in health can occur at any time. Too often, we care for families unprepared for decisions about care that are complex and personal. This project provides tools and guidence to help families talk about end-of-life goals and preferences before a health crisis occurs.


This conversation should not be a 1-time event. Instead, it should happen at key points throughout your life, as your values, goals for care, and preferences change. Use this video as an icebreaker, a public service announcement, or an opening for a discussion over coffee or cocktails, e-mail it, or post it on your Facebook. Help disseminate the call for this conversation[horizontal ellipsis]and use it as a guide for yourself and your family. As the call for this type of conversation expands to the public, health care providers will be ready, informed, and secure in our knowledge that it is the right thing to do.



Rovner J. Medical Schools Reboot For 21st Century Shots: Health News for NPR April 9, 2015.

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The National Public Radio joins the discussion about having conversations with families and patients about care choices during health challenges and at end of life. These are not easy conversations; it is a learned skill, just like any other skill we acquire in health care. It is a skill that must be taught and practiced as we prepare new providers to talk with patients about difficult care decisions.


This represents a major shift from traditional medical educational models. In hospitals and in all care settings, beginning "The Conversation" has been difficult because our traditional health care education has not provided guidance for this process.


This will change. It will change from the top-down as physicians, nurses, social workers, and other providers begin to practice these skills. It will also change from the bottom-up, because patients and families will tell us what matters to them; they may begin the conversation.


The Conversation Project has inspired discussion among academic institutions, hospitals, extended care centers, and now the conversations will come into homes. These discussions are the center of person-centered care and will guide us through transitions as we move from hospital-based care into population-based care.


The author has disclosed that she has no significant relationships with or financial interest in, any commercial companies pertaining to this article.