Articles of Interest

Click on each underlined link ( please note that publishers charge to view links wfollowed by an *) to read the full article:

Hospice and the "End Game"

 By Eleanor Clift

After her husband's death from cancer, a veteran reporter concludes that hospice should be front and center in the debate over the kind of health care future that we want.

Understanding Hospice-An Underutilized Option for Life's Final Chapter

By Gail Gazelle, MD

New England Journal of Medicine-July 26, 2007 

"I'm Not Ready for Hospice”: Strategies for Timely and Effective Hospice Discussions"

By David J. Casarett, MD, MA; and Timothy E. Quill, MD

Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other “bad news” situations. This strategy can make hospice discussions both more compassionate and more effective...

When to Refer to Hospice: Advice to Physicians

By James A. Avery, MD, FACP FCCP. FAAHPM-Former Senior Medical Director, VNSNY Hospice Care

When to refer to hospice seems like such an easy question. Maybe  like most physicians, you know the Hospice Medicare Benefit pretty well and the answer would come quickly: "When a patient has a life expectancy of probably less than six months."  And that is a good answer but it really doesn't get to it....

What Dying Patients Want.  Volunteering at a Hospice Shows a Retired Doctor Peoples' Differing Needs at the End of Life.

By David Baldwin, MD

This poigant article published in Medical Economics and written by a by a retired physician shares his perspective on what he discovered about what dying patients need at the end of life.    

Hospice Care in the Nursing Home Setting: A Review of the Literature

By David G. Stevenson, PhD and Jeffrey S. Bramson, BA

The U.S. Medicare hospice benefit has expanded considerably in the nursing home setting in recent years.  This literature review focuses on the provision of nursing home hospice, exploring its growth and the impact of such care on nursing home residents, cost & efficiency implications for nursing homes and government, policy challenges and important areas for future research.

Comfort Feeding Only: A Proposal to Bring Clarity to Decision-Making Regarding Difficulty with Eating for Persons with Advanced Dementia

By Eric J Palacek MSIV, Joan M. Teno, MD, MS, David J. Casarett, MD, MA, Laura C. Hanson, MD, MPH, Ramona L. Rhodes, MD, MPH and Susan L. Mitchell, MD, MPH

Feeding and eating difficulties leading to weight loss are common in the advanced stages of dementia.  When such problems arise, family members are often faced with making a decision regarding the placement of a percutaneous endoscopic gastrostomy tube.  The existing evidence based on observational studies suggests that feeding tubes do not improve the survival or reduce the risk of aspiration, yet the use of feeding tubes is prevalent in patients with demantia and the majority of nursing home residents do not have orders documenting their wishes about the use of artificial hydration and nutrition. 

Treatment of Cancer Pain

By Russell K. Portenoy, MD

In patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care.  This strategy emphasizes multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family.  

Avoiding Iatrogenic Harm to Patient and Family While Discussing Goals of Care Near the End of Life (*)

By Joseph S. Weiner, MD, PhD and Jesse Roth, MD

Treatment of suffering is a core mission of medicine.  Communication about treatment planning with the patient and family, called the goals of care discussion, offers the opportunity to provide effective relief.  Such communication is particularly important near the end of life, because many medical decisions are determined then by emotional considerations and personal values...