By: Anne H. Montgomery

Published: June, 2014

June 2014 ~ Health Policy Brief No. 10

Summary: Dignity-driven decision making (DDDM) is beginning to move into wider circulation in the U.S. health care system, driven by an accelerating push on two fronts: an imperative to substantially improve the quality of services for individuals with advanced illness by recognizing and incorporating their stated preferences into all aspects of care, and the goal of establishing a degree of consistency and control over costs late in life. To try to tackle these challenges together, DDDM is being formulated as a flexible model for deeply involving individuals with advanced illness, along with their family caregivers in all aspects of treatment, in an ongoing relationship with care teams. Development of the DDDM model has taken off autonomously among several health care providers, including Sutter Health, an integrated health system of 24 hospitals, physician groups and surgery centers based in California and various other community-based health and aging services. The challenge is how to push DDDM beyond the boundaries of initial development to continue the empowerment of patients and focus on ways to ensure that their dignity remains intact as they approach the end of life.

This brief is based in part on a forum hosted by the Campaign to End Unwanted Medical Treatment on March 12, 2014, in Washington, D.C. The session featured remarks by Bruce Vladeck, senior adviser for Nexera, Inc., and head of the Health Care Financing Administration from 1993 to 1997.

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