Talking advanced directives can cut cost


As far as moving through to the finish goes, few documents seem to carry with them more conviction in theory and in linguistic construct than advanced directives. And according to a recent article produced by Dan Morhaim, MD, and Keshia Pollack, PhD — both of the Johns Hopkins Bloomberg School of Public Health — the more consistently advanced directives are completed across the demographic spectrum, the more fluid healthcare on the whole can become in its treatment of end-of-life services.

"The reality is [that] the subject of advance directives is not yet a standard part of most medical examinations," said Morhaim, lead author of the article, said in a news release. "It's important this discussion becomes a routine part of our care giving, because the more normal the topic is, the less scary it will become. As the baby boomer generation continues to age and is impacted by chronic diseases, and as medical technology advances, it is inevitable that healthcare costs will continue to escalate. Increasing awareness and the completion rate of advance directives can have a positive impact on the economic, moral and ethical issues related to end-of-life care."

Recent statistics find that end-of-life care accounts for an estimated 30 percent of all Medicare expenditures, a number that stands to deflate if the rate of advanced directives can do the opposite, Morhaim and Pollack suggest.

"Increasing the rate of completion of advance directives in the United States, empowering individuals and families to determine their care decisions at a critical time, and reducing unwanted end-of-life care expenses needs to become part of the public health agenda,” Pollack said. “Our research shows the public wants to have control of their life, even at the end, and are looking to their physicians or other health professionals to lead the way and initiate these discussions.”

Physicians, nurses and other pertinent healthcare staffers should focus on having more discussions regarding the constructs of advanced directives with patients — doing so can be an honored practice of preventative and cost-saving care.

The report was published in the latest edition of the American Journal of Public Health.