Breaking with the status quo in end-of-life care through de-implementation

Abstract

This paper addresses the challenge of de-implementing low-value care practices in the end-of-life (EOL) context, where burdensome interventions often offer marginal life-extending benefits, incur substantial costs and diminish quality of life. We examine the complexities involved in discontinuing such practices, including clinician biases, institutional cultures favouring aggressive interventions and communication barriers among healthcare providers, patients and families. We discuss how de-implementation at the EOL is unique from other contexts, prioritizing patient-centred care rather than cost reduction. Effective communication and support for patients, families and clinicians is essential, as de-implementation often represents a shift towards what patients and families value. Our review of existing evidence underscores the need for the development and evaluation of de-implementation strategies tailored to EOL care, as described. De-implementation at the EOL requires sensitivity to the complex, emotional nature of EOL care and provides a unique opportunity to integrate palliative care approaches and improve overall EOL care quality.