The study by Dr Biola et al is one of those good-news-bad-news pieces that certainly points out some areas for growth and improvement, while on a positive note demonstrating that both skilled nursing facilities and assisted living facilities are doing a decent job of at least discussing residents' preferences with respect to end-of-life care and life-sustaining treatment (LST). Although this study is of limited scope with about 300 residents from a small sample of facilities in 4 states, there are lessons to be learned from its results. Perhaps most importantly, this work highlights the need for improved processes to ensure that we do indeed provide care that is in keeping with our patients' wishes. We should also be cautious when we use the words "life-sustaining treatment" because they imply to our patients that they actually do sustain life, when in fact we know that in our population, "successful" car-diopulmonary resuscitation (CPR) is a rarity-in spite of the fact that it works almost every time we see it done on television! So it's good to start from that discussion point with our patients and their families. (Even the term "CPR" explicitly contains a reference to "resuscitation," so it is no wonder that people think they will survive it, even without the TV shows)!
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