Sept. 17 (Bloomberg) — Americans aren't getting the support and services they need as death nears, according to a U.S. report calling for an overhaul to the nation's expensive and inefficient approach to end-of-life care.   Doctors need training to talk with their patients about death well before the end of life, a conversation that rarely happens now. Patients, meanwhile, need to take more responsibility to plan for it, according to the report from the Institute of Medicine, a non-profit arm of the National Academy of Sciences that advises lawmakers.   While most Americans say they want to die at home, few do. The majority don't discuss the topic with doctors or family in advance, the report found.   "Patients can, and should, take control of the quality of their life through their entire life, choosing how they live and how they die," said Philip Pizzo, co-chairman of the committee and a professor of pediatrics, microbiology and immunology at Stanford University. "Doctors should help initiate discussions with their patients about such decisions."

The objective is to integrate standard medical care with social services. Together, the planning and care would ease the difficulty of dying and create a new model of high-quality care that is affordable, the 21-member committee concluded in the report, dubbed "Dying in America."