Speakers at the Conference on Improving End-of-Life Care noted that most dying people want to be treated with non-invasive procedures, with hospice care that starts at least three months before death and a chance to die at home.

Studies suggest that current care “is far from this ideal,” although there “appears to be broad agreement that home-based, symptom-guided care is the preferred form of medical care at the end of life,” said conference speaker Elizabeth Lamont, M.D., M.S.

Part of the difficulty in researching better end-of-life care is that definitions of the “end of life” differ among researchers and racial, ethnic, age and disease groups, according to the consensus report. The fragmented health care system may also contribute to confusion and poor quality of life just prior to death, since dying patients often encounter several physicians and specialists who do not coordinate their care.

Policy considerations also loom large in how dying people spend their last days. Half of all Medicare recipients, for example, die in acute care hospitals, the NIH consensus researchers found. Under Medicare, only patients who are certified by their physicians as within six months of death and who give up coverage for life-prolonging treatments can get comprehensive hospice benefits.

“Thus, in reality, it is the minority of persons with life-threatening illness, those with predictable prognoses who are willing to give up life-prolonging efforts, who can benefit from this system,” Sean Morrison, M.D., said.

To read the draft report of the consensus conference, go here.