Sean Morrison
speaker
515 appearances
4 recordings
1 series
first heard Apr 2017
last heard Mar 2022
Sean Morrison’s voice in public audio — every appearance, attributed to the second.
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Appearances
And
Even if you can, I mean, this takes me back 25 years, you know, advanced directives get lost, they get misplaced, they don't get in the medical record.
That was my first JAMA article, just looking at how advanced directives never actually got where they wanted to go.
So we said, aha, we have a problem.
We need to fix, hence the Pinto analogy.
And
The first fix was to say, okay, perhaps rather than just having an advance directive, let's appoint a surrogate who can then read the advance directive and follow wishes.
And the health care proxy was born, and we don't have to go through the decades of research that demonstrated that that in itself was problematic, including the fact that most health care proxies never knew that they were designated as a surrogate.
Which brings us to the next phase, which was advanced care planning, which was, well, if we can't actually predict exactly the situation, perhaps we can have a series of conversations about hypothetical or perhaps even
possible treatment decision in the future so I can understand how those treatments should be made and what decisions you would like me to do.
That seemed like a reasonable fix as well, except for the fact that all of the empirical data that has come out looking at that process
has found that it's ineffectual.
And whereas there is an argument that could be, well, perhaps we need to look further in advance and perhaps it's having something good is happening despite the fact we're not seeing goal-concordant care.
which was the objective of advanced care planning, perhaps it's still good.
And my argument to that is perhaps.
Yet we have more literature and empirical evidence around advanced directives and advanced care planning than we have in almost any other area of palliative care.
And we can't even seem to find a hint that the needle has budged.
And this has consequences because every dollar, every hour that goes into advanced care planning research means that it doesn't go into something else that's important because it is truly, in some respects, a zero-sum game.
There's a fixed pot of NIH dollars.
There's a fixed palliative care research workforce.
Showing 141–160 of 515 · page 8 of 26
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