Can We Do Better? Use of Information and Communication Technologies in End-of-Life Care

By the year 2050, the number of Americans aged 65 and older will top 88.5 million, more than double the aged population in 2010. As baby boomers approach end of life (EOL), the demand for appropriate healthcare resources will expand. Since the publication of the IOM’s landmark 1997 report, Approaching Death: Improving Care at the End of Life, the need for better communication between patients, families, and healthcare providers has been well documented. Failure to communicate EOL preferences has been associated with significant negative health outcomes, including care inconsistent with preferences, unwanted intensive interventions, and delayed referral to hospice, all leading to poor quality of life at EOL. Yet patients, families, and healthcare providers often collude in avoiding communication about EOL. Moreover, spending on health care at EOL continues to rise while quality of life for patients continues to decline, particularly for patients who receive aggressive care at EOL.

New information and communication technologies (ICTs) such as video, computer programs, electronic registries, and electronic health records have begun to transform advance care planning by promoting health literacy and facilitating improved usability, storage and retrieval of documents. ICTs offer the ability to easily tailor content to match individual preferences, adapt to diverse cultural norms, and respond to contextually specific cues. Yet, few resources exist to guide research and interventions in using health IT to improve EOL communication. This paper will present the results of a systematic review of technology-enhanced communication in end-of-life care, highlighting emergent practices in need of further research.