Articles of Interest
Click on each underlined link to read the full article. Please note that the publishers charge to view links are followed by an (*).
Physician Characteristics Strongly Predict Enrollment in Hospice
By: ZiadObermeyer, Brian W. Powers, Maggie Makar, Nancy L, Keating and David M. Cutler
Health Affairs, 34, no. 6 (2015)
These researchers developed a method for measuring the relationship between physician characteristics and hospice enrollment. They found that the proportion of a physican's patients that were enrolled in hospice was a strong predictor of whether the physician's other patients who were not enrolled in hospice would do so.
This document interweaves the stories of Karen Ann Quinlan, Nancy Cruzan and Terry Schiavo with the 40 year history of the end-of-life care movement in the U.S. These poignant stories exemplify the struggles of countless patients and families when making end-of-life decisions. These stories also underscore the chilling fact that despite the advances in medical care, many Americans still suffer from unnnecessary pain, discomfort and inadequate care. Much work is still needed to assure that Americans receive the care they need and want at the end-of-life.
We often find that health care professionals need resources to assist them with conversions from IV narcotic medications to oral and from one medication to another. We offer these two resources to you. Please let us know if you find them helpful.
by Paul Bascom, MD
The words of Dr. Bascom probably strike a chord with many. He believes that after losing his own mother he knows what family members want when their loved one is terminally ill. He writes: "They want our wisdom about prognosis. They want to know when further medical treatment will no longer restore health. They want our guidance and compassionate sharing of the news that death is near."
by Erica Cocoran, MSN, RN, OCN, AOCNS
Dyspnea is a frequent focus of palliative care, which nurses can better address using the skills of comprehensive assessment and an updated knowledge base about approproate medical, pharmaceutical and nonpharmaceutical interventions.
by Shaida Talebreza, MD and Eric Widera, MD
The tools developed for communicating serious news can aid in the process of discussing a hospice referral with a patient and/or family member. One such tool is the SPIKES protocol for delivering bad news. The protocol is comprised of six communication steps using the mnemonic SPIKES: set up, invitation, perception, knowledge, emotion and summary.
by Judith K. Schwarz, PhD, MS, RN
Some hospice and palliative care organizations are considering the merits of creating written policies to guide clinicians' responses to patients' requests for information and support for a voluntarily stopping eating and drinking (VSED)-related hastened death. How hospice clinicians understand the meaning of a request to hasten dying and the legality and morality of the VSED option will determine their responses.
By Daniel Maison, MD. FAAHPM
Anyone who has experienced shortness of breath knows how distressing this can be. Dyspnea is a common symptom at the end of life. Read this article to learn more about managing this this symptom.
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.
By Gail Gazelle, MD
New England Journal of Medicine-July 26, 2007
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...
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.
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.
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...
A short abstract from a full article published in Crit Care Nurs Clin North Am. 2012 Mar;24(1):105-16.
When Treating Cancer Is Not An Option
From the New York Times Personal Health Column by Jane E. Brody, November 19, 2012
Are patients with advanced cancer really informed about the benefits and burdens of chemotherapy? What is a physician's obligation?
Aiding The Doctor who Feels Cancer's Toll
From the New York Times Personal Health Column by Jane E. Brody, November 19, 2012
Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance. What might be helpful for them?
Hospice Enrollment Saves Money for Medicare and Improves Care Quality Across a Number of Different Lengths of Stay
Despite its demonstrated potential to improve quality of care and loer costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. A new study demonstarates savings with shorter enrollment periods.
By Kelly K. Hill, MSN, RN,OCN and Eileen D Hacker, PhD, APN, AOCN
People with life-limiting cancer will make decisions about their end-of-life (EOL) care at some point during their illness. This article explores issues pertaining to EOL conversations between nurses and patients and offers strategies that can be implemented by nurses to aid their patients' transitions to hospice.
By Christine Puchalski, MD
Most patients say they want health care professionals to be aware of the importance of religion or spirituality to them. This tool helps health care professionals to address these issues with patients.