This entry was named an Honorable Mention.
Judges’ comments:
Another hot election topic – this one explained in a very rational and clear and compassionate way. It was the kind of crisp reporting that I would sit in garage for, listening to the end of the report.
1. Provide the title of your story or series and the names of the journalists involved.
“The Economics of End-of-Life Care: Part I & II” was written and reported by Caitlan Carroll. Betsy Streisand edited the series.
Listen to these stories (MP3).
2. List date(s) this work was published or aired.
July 20 & 21, 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
End-of-life care is often the most expensive health care. Many people, when given the option, choose to opt out of experimental therapies and drugs as they approach death, but the current health care system structure provides incentives for more care instead of less. So patients’ wishes can get left out of the equation. This series that aired on the national business show “Marketplace” looked at the reasons behind the growing costs of end-of-life care and how patients’ options may change in the future. The first story explained why the “best” care at the end of life is not always the most expensive care. The story described how the breakneck pace of technological development has led to an over reliance on expensive interventions. Patients are unaware of their options. Health care providers often don’t have the training or tools to provide patients with alternatives to expensive and painful medical interventions. The second story looked at how the conversation surrounding end-of-life care may change. A number of hospitals and other health care providers are creating palliative care teams to treat chronically and terminally ill patients. The hope is that palliative care may increase quality of life and decrease costs for the terminally ill.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I used information from the Dartmouth Atlas of Health Care, a number of studies from leading medical journals, and research from the California Endowment. I also conducted a number of on and off-the-record interviews with health care providers to hear about their personal experiences. A FOI or public act request was not needed in this piece. The documents and data I pulled together on this subject gave me a better picture of the disconnect between the cost of care and the comfort provided. A number of studies I looked at showed that patients who had fewer medical interventions at the end of their lives were actually more comfortable. I also found it interesting that even when medical interventions succeeded in “doubling” a patient’s life expectancy, that could mean living two more weeks instead of one. Often that small increase of time, came with a lot of pain and expense.
5. Explain types of human sources used.
I spoke with a number of health care experts and care givers like Rosemary Gibson, the head of the Robert Wood Johnson Foundation’s program to improve end-of-life care; Howard Gleckman, a fellow at the Urban Institute and the author of “Caring for Our Parents”; Henry Aaron, a health care economist at the Brookings Institution; Don Schumacher, the head of the National Hospice and Palliative Care Organization; and Andrew Holtz, the author of the Holtz Report. I also visited the San Diego Palliative Care Institute and met with trainees, administrators, patients, and family members.
6. Results (if any).
The two-story series started a long dialogue on our website. We received many comments from our listeners like this one from John Thoma in Raleigh, NC: “Thank you Marketplace for having the courage and foresight to address death and dying in our culture and to challenge existing norms in health care. In the midst of fears and conflicting incentives, the individual person’s goals and wishes for care are often drowned out, misunderstood, or cannot physically be communicated. I applaud you for debunking the myth of death panels. End of life decision-making is really about giving persons and their caregivers a voice and empowerment to make informed choices base on their goals and values.” I was glad that the stories sparked our listeners’ interest. I would like to report some follow-up stories addressing our listeners’ questions. For instance, a few listeners wanted more reporting on the hospice industry. A lot of questions came up about non-profit and for-profit hospices. I think this is an area that warrants more exploration.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
8. Advice to other journalists planning a similar story or project.
Talking about the costs of care for people who are dying is a delicate subject. My editor and I spent a lot of time thinking about the tone of the pieces. We wanted to get at the economics of the story but not lose sight of the emotion. The way I bridged this tension was by personalizing part of the first story. Most people have lost someone close to them. I spoke about my father’s death to connect with listeners and make the story less clinical. There are other ways to make a business story human. My advice would be to not shy away from the economic side of health care. I think a lot of people have a hard time discussing money and treatment options. As reporters, we can give listeners and readers a neutral venue to explore these questions.