title: Patient-Physician End-of-Life Discussions in the Routine Care of Medicare Beneficiaries.
abstract: OBJECTIVE
  Medicare reimbursement for physicians who discussed end-of-life care and planning with a patient during an office visit was cut from the 2010 Affordable Care Act. We assessed the characteristics of patients who reported having had such discussions, and whether these discussions are associated with trust in one's physicians and with rates of family advance care planning (FACP).
  
  
  METHODS
  The sample consisted of 5,199 Medicare beneficiaries who reported having an ongoing relationship with a primary care physician. We estimated ordinal and multinomial logistic regressions that controlled for health care utilization, current health, and recent family deaths.
  
  
  RESULTS
  Less than 1% (n = 310) reported an end-of-life conversation with a physician during the course of routine care. However, conversations were associated with greater trust in one's physician and higher rates of completion of FACP.
  
  
  CONCLUSIONS
  Findings support renewed efforts to reimburse physicians for discussing end of life with their Medicare patients.
authors: Boston College, Chestnut Hill, MA, USA millertq@bc.edu.
authors: Sara
authors: S
authors: Keary
authors: Boston College, Chestnut Hill, MA, USA.
authors: Sara M
authors: SM
authors: Moorman
mesh_terms: D032722:Advance Care Planning / Q000191:economics / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000191:economics / Q000523:psychology*; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence; D035502:Trust; D014481:United States
keywords: advance directives; discussion; end-of-life care preparation
references: Arch Intern Med. 2000 Dec 11-25;160(22):3477-85
references: 11112242
references: Fam Med. 2001 Jan;33(1):22-7
references: 11199905
references: Behav Sci Law. 2002;20(3):235-52
references: 12111986
references: Med Care Res Rev. 2002 Sep;59(3):293-318
references: 12205830
references: Soc Sci Med. 2003 Oct;57(7):1195-203
references: 12899904
references: Crit Care Med. 2004 Jul;32(7):1484-8
references: 15241092
references: J Fam Pract. 2005 Apr;54(4):344-52
references: 15833226
references: Crit Care Med. 2006 Jun;34(6):1679-85
references: 16625131
references: J Gen Intern Med. 2007 Apr;22(4):495-501
references: 17372799
references: J Gerontol B Psychol Sci Soc Sci. 2007 Mar;62(2):S135-41
references: 17379683
references: Am J Public Health. 2007 Jul;97(7):1283-9
references: 17538069
references: J Am Geriatr Soc. 2008 Jun;56(6):1006-13
references: 18410324
references: JAMA. 2008 Oct 8;300(14):1665-73
references: 18840840
references: Health Care Anal. 2009 Sep;17(3):244-60
references: 19130247
references: J Am Geriatr Soc. 2009 Jan;57(1):31-9
references: 19170789
references: Arch Intern Med. 2009 Mar 9;169(5):480-8
references: 19273778
references: J Am Geriatr Soc. 2009 Sep;57(9):1547-55
references: 19682120
references: Cancer. 2010 Feb 15;116(4):998-1006
references: 20066693
references: J Clin Oncol. 2010 Mar 1;28(7):1203-8
references: 20124172
references: Patient Educ Couns. 2011 Dec;85(3):406-12
references: 21269794
references: Omega (Westport). 2011;63(1):1-20
references: 21748919
references: Ann Intern Med. 2012 Feb 7;156(3):204-10
references: 22312140
references: Gerontologist. 2012 Dec;52(6):770-81
references: 22547085
references: J Clin Oncol. 2012 Dec 10;30(35):4387-95
references: 23150700
references: Gynecol Oncol. 2013 Jul;130(1):156-61
references: 23587882
references: Hastings Cent Rep. 2013 Jul-Aug;43(4):30-2
references: 23842921
references: Int J Epidemiol. 2014 Feb;43(1):34-41
references: 24585852
references: J Gen Intern Med. 1994 Feb;9(2):82-8
references: 8164082
references: JAMA. 1996 Jun 5;275(21):1693-7
references: 8637148
references: Ann Intern Med. 1998 Sep 15;129(6):441-9
references: 9735081