A new report from the Institute of Medicine is calling for major changes in the way the U.S. healthcare system helps to meet end of life needs for patients and their families.

The report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,” comes from a 21-member committee, and provides suggestions to integrate traditional medical care and social services to improve the quality and affordability of end-of-life care.

One major hurdle is simply getting the conversation started. Surveys have shown that 90 percent of American adults feel that having family conversations about end-of-life wishes is important, yet less than one-third have actually had such a conversation, according to the Institute of Medicine.

A model of “advance care planning” is needed to fill in the gaps, recommended the committee. This includes clarifying related values and goals, along with making sure that written documents account for patient preferences. Conversations about end-of-life goals could coincide with certain life milestones, as early as when turning 18 or when a person gets married. The committee also recommended other situations, such as when a person enters a high-risk occupation or contracts a chronic illness that should trigger end-of-life planning discussions.

For clinicians who care for patients with serious illnesses, the committee recommended improved training and certification to boost communication skills and symptom management. Governments and payers in the private sector could also incentivize clinicians to discuss end-of-life matters.

This kind of advanced care planning model could also benefit healthcare costs, in addition to improving care for individual patients. Better managing pain, reducing emergency room visits and limiting 911 calls by better preparing for preventable crises would all rein in costs and could be a side effect of better end-of-life planning.

“This is one of the most comprehensive and up-to-date studies that has been performed on end-of-life care for people of all ages who are approaching death,” said Victor Dzau, MD, president of the Institute of Medicine, in a statement.  “Healthcare delivery for people nearing the end of life has changed remarkably since IOM published its 1997 report Approaching Death: Improving Care at the End of Life.  Since that report, the number of palliative care teams within hospital settings has increased, and palliative care is well-established in the professions of medicine, nursing and social work. The time is now for our nation to develop a modernized end-of-life care system as envisioned by this report.”