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Death of outrage over talking about dying
  1. Nrupen A Bhavsar1,
  2. Sara Constand2,
  3. Matthew Harker3 and
  4. Donald H Taylor Jr3,4
  1. 1 Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  2. 2 Duke University, Durham, North Carolina, USA
  3. 3 Duke Clinical Research Institute, Durham, North Carolina, USA
  4. 4 Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Nrupen Bhavsar, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 411 W. Chapel Hill, St. Suite 500, Durham, NC 27701, USA; nrupen.bhavsar{at}


Objectives We examined public reaction to the proposed Center for Medicare and Medicaid Services rule reimbursing physicians for advanced care planning (ACP) discussions with patients.

Methods Public comments made on were reviewed for relevance to ACP policy and their perceived position on ACP (ie, positive, negative and neutral). Descriptive statistics were used to quantify the results.

Results A total of 2225 comments were submitted to On review, 69.0% were categorised as irrelevant; among relevant comments (n=689), 81.1% were positive, 18.6% were negative and 0.002% were neutral. Individuals submitted a greater percentage of the total comments as compared to organisations (63.5% and 36.5%, respectively).

Conclusions The US Medicare programme is a tax financed social insurance programme that covers all patients 65 years of age and older, including 8 in 10 decedents annually, and it is the part of the US healthcare system most similar to the rest of world. There has been a trend globally towards recognising the importance of aligning patient preferences with care options, including palliative care to deal with advanced life limiting illness. However, ACP is not widely used in the USA, potentially reducing the use of palliative care. Reimbursing ACP discussions between physicians, patients and their family has the potential to have a large impact on the quality of life of persons near death, which can greatly impact public health and the comfort in dealing with our ultimate demise.

  • palliative care
  • Hospice care
  • advance care planning
  • health policy

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  • Contributors All authors have participated in the design of the study, analysis and/or drafting and reviewing of the manuscript.

  • Funding The project described was supported by grant number 1C1CMS331331 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

  • Disclaimer The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies.

  • Competing interests None declared.

  • Ethics approval The study was a review of comments on a publicly available website. Approval of the study by the institutional IRB was deemed not necessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.