Dying in America (Part I): Reflections on IOM Report

The Institute of Medicine (IOM) recently released a report entitled “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.”

While the title specifies end of life care, the report itself notes that many of the recommendations would likely benefit many other patient groups. In other words, improving the care of those near the end of life requires changes that occur long before that time.

In my own work, I learned very early on that you can’t possibly do excellent end of life care if you wait until the end of life. It has to begin early on.

What is the Institute of Medicine?

It is worth taking a moment to understand who the Institute of Medicine is. This is not a government agency. It is an independent arm of the National Academy of Sciences.

The work they do is funded by sponsors of specific projects. Sometimes those sponsors are from the government, who would like expert information about a specific topic. Sometimes it comes from other institutions that provide grant funding. This particular report was funded by an anonymous individual.

Once a report is chartered (the specific charter is negotiated between the IOM and the sponsor), the sponsor steps aside. The work then becomes strictly the IOM itself. There is no investigator bias. In fact, the members of the work groups are determined solely by the IOM, as are the findings and recommendations.

Bottom line, and the reason I call this out, is that an IOM report is an unbiased report based on the knowledge of experts. There is no political agenda hidden anywhere. Given the recent debacle surrounding so-called “death panels”, this is a key fact to keep in mind.

It’s Not the First Time

Something else that is notable is that this is not the first time the IOM has published a report about end of life.  In 1997, “Approaching Death: Improving Care at the End of Life” was released, then in 2003, it was followed by “When Children Die: Improving Palliative and End-of-Life Care for Children and their Families”.

Several other reports have mentioned palliative care, such that there have been 6 reports total in the last decade that call out the importance of these issues.

The Bottom Line?

If you are a “bottom line” kind of person, the report could probably be summarized as follows:

  • Dying in America is hard.
  • Palliative care works, and makes it easier.
  • Folks don’t really know what palliative care is, but once they learn, they see its value and want it.
  • We can do a better job in education for professionals and the general public
  • We must fix the misaligned incentives that lead to unwanted treatments.
  • We have to understand what patients and families value, and align those values to the care we deliver.
  • We have to help families take care of their loved ones.

Sounds deceptively simple. The devil, of course, is in the details. In future posts, I’ll dive in to these areas more deeply.

For now, please let me know in the comments section of the blog which of these areas are of most interest to you, or which are the most troubling. I look forward to interacting on this topic!

About Author: Robert Sawicki, MD

Doctor Robert Sawicki photoDr. Robert Sawicki is the Vice President of Clinical Services for OSF Home Care and Post-Acute Services. He has led efforts to develop and improve care for patients with chronic illnesses and has a special interest in end-of-life care and hospice.

Dr. Sawicki received his medical degree from Rush University in Chicago, Illinois, and completed his residency in family medicine in Rockford. He practiced family medicine in Bloomington, Illinois, for 20 years before moving into leadership roles with OSF Home Care Services.

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Categories: Palliative Care & Hospice