Breaking with the status quo in end-of-life care through de-implementation.

Area of Science:

• Medical Ethics
• Palliative Care
• Healthcare Management

Background:

• Low-value care practices persist in end-of-life (EOL) settings, offering minimal benefits while diminishing quality of life.
• Discontinuing these practices faces challenges like clinician biases, institutional norms, and communication gaps.
• EOL de-implementation uniquely prioritizes patient values over cost reduction.

Purpose of the Study:

• To examine the complexities of de-implementing low-value care in the EOL context.
• To highlight the unique aspects of EOL de-implementation compared to other healthcare settings.
• To emphasize the need for tailored de-implementation strategies and palliative care integration.

Main Methods:

• Review of existing evidence on de-implementation in EOL care.
• Analysis of challenges including clinician biases, institutional culture, and communication barriers.
• Discussion of the unique patient-centered approach required for EOL de-implementation.

Main Results:

• De-implementation at the EOL is distinct, focusing on patient-centered values and quality of life.
• Effective communication and support are vital for successful transitions in care.
• Existing evidence highlights the need for specific de-implementation strategies for EOL settings.

Conclusions:

• Developing and evaluating tailored de-implementation strategies is essential for improving EOL care quality.
• Integrating palliative care approaches is a key opportunity within EOL de-implementation.
• Sensitivity to the emotional and complex nature of EOL care is paramount for successful practice change.