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Massachusetts end-of-life education gets slow start

Many people don't include end-of-life health care provisions in estate plans because death is a subject most people want to avoid. Strategizing asset transfers for heirs may provide the emotional distance from death that long term care planning for the elderly does not.

Massachusetts lawmakers and health care providers also have hesitated to carry out incapacitation planning initiatives recommended two years ago by a state-sanctioned panel. Panel experts strongly advised public and patient education about end-of-life choices.

Combined surveys revealed that 67 percent of state residents wish to die at home. Only about one-quarter of those who die experience that kind of death. Less than 20 percent have ever spoken to their doctors about end-of-life medical preferences.

The panel urged state-monitored caregiver training throughout health care facilities. Hospice care availability for Medicaid patients was suggested along with online campaigns to promote end-of-life options at hospitals. Gov. Deval Patrick's administration says putting recommendations into effect takes money the state hasn't budgeted.

A Massachusetts General Hospital physician developed a series of videos that help patients make end-of-life health care choices. The doctor conducted a study of late-stage cancer patients. Doctors explained the end-of-life medical interventions to some patients and showed a realistic video depicting how the treatments were administered to others. Patients who viewed the videos were twice as likely to dismiss CPR and breathing machines as care options.

A new state law will require health care facilities across-the-board to provide information on palliative care for "appropriate patients." State officials are grappling with distribution plans and identifying patients who need the care most.

A training program called MOLST has begun in more than 160 health care facilities. Staff members learn how to talk with patients about end-of-life options. Patients who sign MOLST forms give health care workers detailed instructions about treatments they would prefer.

Attorneys assist clients with the legal aspects and incorporation of final medical treatment choices in estate plans.

Source: bostonglobe.com, "End-of-life care rarely discussed," Kay Lazar, Jan. 21, 2013

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