Vox reported on dying in America based on the research by Kaiser Health News, a nonprofit national health policy news service, with support from The SCAN Foundation.  15 years ago, the Institute of Medicine released its seminal 1997 report detailing the suffering many Americans experience at the end of life and offering sweeping recommendations on how to improve care.  It has gotten worse since then.

Despite efforts to build hospice and palliative care programs across the country, the number of Americans experiencing pain in the last year of life actually increased by nearly 12 percent between 1998 and 2010, according to a study released in the Annals of Internal Medicine. In addition, depression in the last year of life increased by more than 26 percent  even though guidelines and quality measures for end-of-life care were developed, the number of palliative care programs rose and hospice use doubled between 2000 and 2009.

Most physicians tend to under-treat pain and other symptoms at the end of life because they don’t recognize them or are hesitant to talk candidly about the process of dying and the pain associated with it, said Dr. Tim Ihrig, a palliative care physician at UnityPoint Health in Fort Dodge, Iowa.

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