Improving Advance Care Planning: Research Results from the “Conversation Starters” Focus Groups and “Conversation Stopper” Physician Survey
The John A. Hartford Foundation is pleased to collaborate with the California Health Care Foundation and Cambia Health Foundation in conducting a national survey and series of focus groups on improving Advance Care Planning, as well as exploring the barriers that can make these important conversations more challenging.
On this page you will find:
Information on the “Conversation Starters” focus groups with clinicians as well as consumers, released December 1, 2016.
Information on the “Conversation Stopper” physician survey, released April 2016.
"Conversation Starters” Focus Groups with Clinicians and Consumers
Discussions about end-of-life and serious illness care, which are now reimbursable through Medicare, make it more likely that patients will receive the kind of care they want, yet these critical conversations often fall short, start too late, or don’t happen at all. New focus group research provides insights into practical ways to improve advance care planning (ACP).
The John A. Hartford Foundation, the California Health Care Foundation (CHCF), and Cambia Health Foundation commissioned “Conversation Starters”: six focus groups about advance care planning made up of clinicians (general practitioners, internists, oncologists, cardiologists, pulmonologists, nurse practitioners, and physician assistants). A seventh focus group, composed of 31 racially and culturally diverse adults age 40+ who have an advance care plan, was conducted online. The focus groups were conducted by PerryUndem Research/Communications.
For more information on the focus groups, please explore the following materials:
- NEW REPORT: Conversation Starters: Research Insights from Clinicians and Patients on Conversations About End-of-Life Care and Wishes
- Health AGEnda Blog Post: From Best Practice to Common Practice: New Report Reveals Ideas to Start and Spread Advance Care Planning by Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation
- Press Release
- Webinar slides from a webinar featuring Terry Fulmer; Ellen Goodman, Co-Founder and Director of The Conversation Project; Susan Block, MD, Director of Serious Illness Care Program at Ariadne Labs, Founding Chair of the Department of Psychosocial Oncology and Palliative Care at Dana-Farmer Cancer Institute and Brigham and Womans's Hospital, Co-Director of the Harvard Medical School Center for Palliative Care, Professor of Psychiatry and Medicine at Harvard Medical School; Sandra R. Hernandez, MD, President and CEO of the California Health Foundation; Angela Hult, Director of Cambia Health Foundation
- A recording of that webinar can be accessed here (Adobe Flash required).
Media Coverage
Chicago Tribune: Doctors slow to have end-of-life conversations
MedPage Today: End-of-Life Talks: Vital But Not Happening
“Conversation Stopper” Physician Survey
In April 2016, The John A. Hartford Foundation, California Health Care Foundation and Cambia Health Foundation released findings from a national poll exploring the views of primary care and specialist physicians about end-of-life and advance care planning conversations with patients.
In Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning? virtually all physicians surveyed agree that talking with patients about end-of-life and advance care planning is important, and they overwhelmingly support a new Medicare benefit that reimburses them for having those discussions. The survey also identified barriers that keep physicians from engaging in these sensitive conversations, with nearly half (46 percent) reporting that they frequently or sometimes feel unsure of what to say, and less than one-third (29 percent) reporting having had any formal training specifically on talking with patients and their families about end-of-life care.
For more information on the survey, please explore the following materials:
- Topline poll results and Poll Memo by PerryUndem Research/Communication
-
Health AGEnda Blog Post: Talking with Patients about End-of-Life Care: New Poll Reveals How Physicians Really Feel by Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation
- Webinar slides from a briefing webinar featuring Terry Fulmer; Tressa Undem, MA, Partner at PerryUndem Research/Communication; and Tony Back, MD, Co-Director of the University of Washington’s Cambia Palliative Care Center of Excellence and Executive Director of Vital Talk
- A recording of that webinar can be accessed here (Adobe Flash required).
Media Coverage
Associated Press: Elderly book end-of-life talks once labeled 'death panels'
Boston Globe: Most doctors ill-equipped to give end-of-life care, survey finds
Forbes: Doctors Have Barriers To End-Of-Life Discussions Despite Medicare Coverage
Marketwatch (Dow Jones): You need to talk to your doctor about how you want to die
Also appeared on MSN.com.
Reuters: COLUMN-U.S. Medicare end-of-life counseling off to slow start
The Atlantic: Discussing Death Over Dinner
Also appeared in Retirement Revised.
Kaiser Health News/California Healthline: Most Doctors Unsure How To Discuss End-of-Life Care, Survey Says
This story has also been reprinted widely in the following publications:
- CNN.com
- NPR Shots blog
- New England Public Radio
- Healthcare Finance News
- KPBS
- Med City News
- Seattle Local HealthGuide
Next Avenue: Dinner Parties Encourage Talk About Death
Also appeared on FORBES.com.
The Washington Post Writers Group syndicated writer Esther Cepeda
Des Moines Register: When Doctors Talk About Dying
MedPage Today: Docs Still Flinching on Advanced Care Planning
Medscape: End-of-Life Conversation Stoppers Revealed in New Survey
Long-Term Living Magazine: Having 'the talk' about death
McKnight's Senior Living: Survey reveals barriers to end-of-life, advance care planning discussions
New America Media: Study: With New Medicare Benefit, Doctors Look Beyond 'Death Panels'
The Hill: Poll: Doctors find barriers to end-of-life talks
Becker's Hospital Review: 24% of physicians say their EHRs can't accommodate end-of-life planning
Fierce Practice Management: Lack of Physician Training Still Hampers End-of-Life Conversations
Tech Times: Doctors Find It Difficult To Advise Patients About End-Of-Life Care
MaineNewsOnline.com: Physicians Face Barriers to Have End-of-Life Conversations with Medicare Patients
Las Vegas Review Journal: Time to Discuss End-of-Life Decisions is Now, National Healthcare Decisions Day
MedicalDaily.com: End-Of-Life, Palliative-Care Discussions Are Hard, Even For Doctors
The News Recorder: Doctors Says Talking With Patients About End-Of-Life Care Difficult But Very Important
Hospice and Palliative Medicine SmartBrief
Assisted Living Federation of America / Argentum: Doctors Find Themselves Stumped When Discussing End-of-Life Planning
Pulse Headlines: Is the U.S. healthcare system ready to talk about end-of-life wishes?
ThinkProgress: What Doctors Should Be Asking Their Patients About How They Want To Die
Today’s Hospitalist newsletter: Weekly News Briefs for Hospitalists
DecisionHealth Part B News (subscription): Survey: M.D.s find lack of time, patient-family conflict obstacles to ACP
Ventura County Star: Push for living wills places focus on end-of-life desires
Mirror Daily: End-of-Life Talks are Hard for Doctors
News Everyday: Doctors Find Discussing End of Life Care Difficult to Patient, Study Finds
Visiting Nurse Association of America: Health Care Collaboration Releases Poll Findings on End-of-Life and Advanced Care Conversations
The Pew Charitable Trust: Poll: Doctors Want to Discuss End-of-Life Issues, but Barriers Remain
Health Payer Intelligence: End-of-Life Counseling Sessions Stall despite Medicare Payment
Health Leaders Media: Despite New Funding, Few Docs Discuss Advanced Care Planning
Journal Article
Journal of the American Geriatrics (JAGS): Physicians' Views on Advance Care Planning and End‐of‐Life Care Conversations, Terry Fulmer, Marcus Escobedo, Amy Berman, Mary Jane Koren, Sandra Hernández, and Angela Hult, 23 May, 2018
Background on the Poll
This survey of 736 physicians in 50 states who see patients 65 and older was conducted by PerryUndem Research/Communications and has a sampling margin of error of +/- 3.6 percentage points. It was released April 14, 2016.