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Toward evidence-based end-of-life care

New England Journal of Medicine

Toward evidence-based end-of-life care

NEW ENGLAND JOURNAL OF MEDICINE | Online – 14 October 2015 –The disquieting patterns of endof-

life care in the U.S. have been well documented. In the last month of life, one in two Medicare beneficiaries

visits an emergency department, one in three is admitted to an intensive care unit, and one in five

has inpatient surgery. But one of the most sobering facts is that no current policy or practice designed to

improve care for millions of dying Americans is backed by a fraction of the evidence that the Food & Drug

Administration would require to approve even a relatively innocuous drug. For example, more than two

thirds of U.S. states have implemented Physician (or Medical) Orders for Life-Sustaining Treatment

(POLST/MOLST) programs despite the absence of compelling evidence that they improve patient outcomes.

Even less evidence is available to support such well-intentioned private initiatives as the Institute

for Healthcare Improvement Conversation Project, the efforts of the Coalition to Transform Advanced

Care, the Gundersen Health System's Respecting Choices program, the widely used Five Wishes advance

directive of the Aging with Dignity organization, and the services provided by for-profit companies

such as Vital Decisions and Common Practice.

Contact Information

Center for Research on End-of-Life Care Weill Cornell Medical College 525 E 68th St, Box 39, 1414 Baker Pavilion New York, NY 10065 Phone: (212) 746-4409