WASHINGTON, D.C. —A nationwide poll of doctors released today by National Journal and The Regence Foundation finds physicians near-unanimous in their support for prioritizing end-of-life options such as palliative care. However, the poll also revealed notable hesitations about how to handle end-of-life discussions with patients as well as barriers to expanding access to palliative care.

According to the poll - the last in a three-part series called "Living Well at the End of Life: A National Conversation" - 96% of the 500 board-certified physicians surveyed believe enhancing the quality of life for seriously ill patients is more important than extending life as long as possible. When the same question was posed to Americans as a whole in February, 71% of the respondents professed that belief.

In February's national poll, only 37% of Americans overall agreed that the health care system spends too much trying to extend the lives of seriously ill patients, with 55% saying the system has the responsibility to spend whatever it takes. Today's poll shows physicians view the situation differently, with 79% saying the system spends too much, and only 21% taking the opposite view. The physicians are also in near-unanimous agreement (96%) that the health care system should place a higher priority on providing palliative care to all patients who need and want it.

However, despite those strong feelings of support, a large percentage of physicians (42%) expressed concern that emphasizing palliative care could interfere with doing whatever it takes to help patients extend their lives as long as possible. Two-thirds of the physicians who have discussed palliative care with their patients say the patients are not well-informed about their options, and about a quarter say they're reluctant to recommend palliative care because their patients may believe they're not doing everything possible to extend their lives. Physicians identify these issues, as well as limitations in resources and services, as significant barriers to providing palliative care.

"This path-breaking series of polls has provided an unprecedented portrait of how average Americans and physicians alike approach the complex and emotionally fraught issues at the end of life," said National Journal editorial director Ronald Brownstein. "This latest survey shows an overwhelming consensus among physicians that all elements of the medical community need to do a better job in providing options to patients at this difficult time - but that many obstacles remain in the way of reaching that goal."

"Ultimately, palliative care is deeply personal. It’s about caring for seriously ill patients and their families, helping them to have difficult conversations, and respecting the choices they make," said Peggy Maguire, Regence Foundation board chair. "As a health care system, our focus needs to be on removing the palliative care barriers that patients and providers face, and ensuring people have the information and resources they need to live well at the end of life."

The poll's results were discussed in-depth today at a National Journal LIVE event in Washington, D.C., featuring former White House Office of Management and Budget Special Health Adviser Dr. Zeke Emanuel and a panel of health care providers, experts and educators.

The National Journal-Regence Foundation poll top-line results (PDF). Key survey findings include:

1. Physicians express an overwhelmingly positive impression of palliative care and believe it needs to be a top priority for the country’s health care system.

• Physicians are nearly unanimous in believing that "it is more important to enhance the quality of life for seriously ill patients" (96%) versus "it is more important to extend life through every medical intervention possible" (4%).

• An earlier poll found only 71% of Americans in general agreed with the first statement.

• Physicians also overwhelmingly believe that "the health care system spends far too much trying to extend lives" (79%) versus "the health care system has the responsibility, the technology and the expertise to offer treatments and spend whatever it takes to extend lives" (21%).

• An earlier poll found only 37% of Americans in general agreed with the first statement.

• There is near unanimous agreement (96%) with the idea that the health care system should place a higher priority on providing palliative care to all patients who need it and want it.

• 95% of physicians say patients should be allowed to choose treatment options that align with their goals and values, including choosing to decline life-extending treatment.
• Nearly all physicians say palliative care should be fully covered by health insurance (95%) and Medicare (94%).

2. The data reveals noteworthy hesitations about palliative care and barriers to its full adoption.

• A large percentage of physicians (42%) agree that emphasizing palliative care could interfere with doing whatever it takes to help patients extend their lives as long as possible.

• 24% of physicians agree that they are reluctant to recommend palliative care because patients may conclude they are not doing everything possible to extend the patient’s life.
• 25% say they are not prepared to counsel patients about their options for end-of-life care.

• Among the 88% of physicians who have discussed palliative care with patients to some extent, two-thirds (67%) say that patients are not well informed about their palliative care options.
• The vast majority of physicians believe that barriers to providing palliative care exist in uninformed patients (91%) and patients reluctant to accept that they may not recover (84%).
• Most physicians believe that elected officials and policymakers (75%), health insurance providers (61%) and, hospital administrators (52%) perform poorly at ensuring successful palliative care outcomes for patients.
• Physicians believe that reimbursement (82%), inadequate patient resources (78%), and a shortage of palliative care physicians and services (78%) are barriers to providing palliative care.

3. There is a dramatic "generation gap" in physicians' education and training about palliative care.

• Just one-in-three (33%) physicians say they had "a great deal" or "some" exposure to palliative care education and training in medical school, while less than half (45%) received "a great deal" or "some" exposure during their residency.
• 73% of physicians age 39 or younger report "a great deal" or "some" exposure to palliative care during medical school, compared to just 36% of those age 40-49, 23% of those age 50-59, and only 6% of those age 60 or older.

Note: This survey was conducted October 28 to November 2, 2011, by FTI Strategic Communications among 500 board-certified physicians. The survey has a margin of error of plus or minus 4.0% percent in 95 out of 100 cases in each state.