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.

NHPCO Monograph-Private Conversations Public Discourse

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.

Equianalgesic Tables

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.

Equianalgesic Table for Adults: Half Life, Duration, Dosing and Guidelines

Equianalgesic Table for Pediatrics: Half Life, Duration, Dosing and Guidelines

Many Stories of My Mother's Death

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."

Palliative Care and Dyspnea

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. 

The Hospice Referral

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.  

Hospice Care for Patients Who Choose to Voluntarily Stop Eating and Drinking (VSED)

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.

Managing Dyspnea

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. 

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.

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...

ICU Nurses Advocating for Hospice in the ICU

A short abstract from a full article published in Crit Care Nurs Clin North Am. 2012 Mar;24(1):105-16.

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.

Helping Patients with Cancer Prepare for Hospice

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.

The FICA Spiritual History Tool

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.