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EOL treatment misconceptions can lead to bad experiences

NPR’s recent article For many, a 'natural death' may be preferable to enduring CPR by Clayton Dalton offers several insights worth highlighting. A key point centers on the public’s misconceptions about the effectiveness of end-of-life (EOL) treatments - in this case CPR.

The article notes that CPR survival rates on TV are between 70-75 percent, compared an actual survival rate of 7.6 percent. This TV experience helps create unrealistic expectations for the public. In fact, outcomes for patients with chronic illnesses have an even worse outcome at 2 percent.

The negative impact of treatment on patients was also highlighted: “The traumatic nature of CPR may be why as many as half of patients who survive wish the hadn’t received it, even though they lived with it.”

The article goes onto quote Holland Kaplan, a physician and bioethicist who observed that “bad experiences [from CPR] far outnumber the good ones, unfortunately.”

The article identifies three strategies to address these problems:

  1. Education: studies have found half of patients changed their wishes when they learned the true survival rates of CPR, or after watching a video depicting the reality of CPR.

  2. Communication: According to one survey, 92 percent of Americans believe it’s important to discuss EOL care, but only 32 percent have done so. These conversations are important.

  3. Language matters: How we describe our expectations for treatment at EOL makes a dramatic difference. A common phrase used by families is “we want everything done.” Unfortunately, this language means you may receive futile care and painful treatments because this request ignores low likelihood of success. Add the fact that malpractice threatens all physicians, and you will receive over-treatment. In the alternative, the phrase “allow a natural death” can result in a more compassionate EOL care experience.

My book The Journey's End offers patients and caregivers an education on all these EOL issues and goes onto to offer recommendations on how to reform the health system so that these recommendations are implemented.

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