An ethnographic study of palliative care specialists reveals that many of them find dealing with dying patients a gratifying experience. The scant evidence about oncologists on this subject paints a much different picture.
ASCO’s QOPI analysis recently found that less than half of all cancer patients are enrolled in hospice care before their death and of those who are enrolled, one-third are not enrolled until the last week of their lives. In response to this and other findings, ASCO published a new policy and guidelines this week, intended to encourage physicians to initiate open dialogue about palliative care and treatment with patients as soon as they are identified as having incurable cancer.
On average, 11% of cancer patients drop out of hospice care, according to research conducted at the Mount Sinai School of Medicine. Many of these patients are in for rough sledding.
Studies have shown that underutilization of hospice care increases end-of-life costs; more aggressive use of hospice could lead to significant savings and better care. Medicare seems to understand that promoting hospice care is not a "Death Panel."
Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
When Hospice Is the Best Option: An Opportunity to Redefine Goals Maryjo Prince-Paul, PhD, APRN, ACHPN
Assistant Professor, Frances Payne Bolton School
of Nursing
Case Western Reserve University, Cleveland, Ohio
Postdoctoral Fellow, R25T-NIH/NCI,
Case Comprehensive Cancer Center
University Hospitals/Case Medical Center,
Cleveland, Ohio , April 7, 2009
Ms. D is a 45-year-old woman with ovarian cancer and hepatic metastatic disease. She has received multimodal treatment over the past 5 years. Ms. D lives in her own home, is divorced, and is a single parent of two adolescent children. Her mother is her primary caregiver and also has a deteriorating health condition.
Three cancer organizations have joined in supporting FDA in an appeal to the District of Columbia Circuit Court of Appeals to overturn a decision that terminally ill patients have a fundamental right of access to experimental drugs.
In an ideal world, palliative care would be integrated into therapeutic care from the time of cancer diagnosis—not limited to hospice or end-of-life care.
The Lung Cancer Alliance applauded a recent court decision on the rights of terminally ill cancer patients to take experimental drugs. In 2003, The Abigail Alliance and the Washington Legal Foundation filed suit against the Food and Drug Administration (FDA) in order to give terminally ill cancer patients access to drugs that have passed initial safety tests but not the full regalia of clinical trials normally required for approval.
Initiating discussions about end-of-life care with patients with incurable cancers early in their disease was associated with a decrease in late-stage... More »
Giving patients at the end of life regular parenteral hydration of 1 L of saline per day did not improve symptoms associated with hydration, quality... More »
A significant portion of patients with incurable lung cancer believe that palliative radiation therapy will cure the disease or at least help them... More »
Adolescents and young adults want to be more involved in specific aspects of their end-of-life care and found a planning document to aid in those... More »
When facing decisions involving children with cancer at the end of life, three themes drove parental decision making--communication, extending time,... More »
Commentary on: Kent B, Anderson NE, Owens RG. Nurses’ early experiences with patient death: the results of an on-line survey of Registered Nurses in New Zealand. Int J Nurs Stud 2012;49:1255–65.
Implications for practice and research
The study draws attention to the issue of patient death and its impact on staff well-being, moral and mental health, calling for these areas to be taken more seriously.
This Registered Nurses' Association of Ontario (RNAO) clinical best practice guideline provide evidence-based recommendations for registered nurses and registered practical nurses on best nursing practices for end-of-life care during the last day
Advance directives (ADs) are one of the few means for patients to indicate their end-of-life (EOL) treatment option preference. An effective and consistent solution for increasing the AD completion rate remains elusive. A literature search revealed three studies completed in the United States that employed an identical methodology and focused on registered nurses (RNs). These studies examined a variety of concepts, including nurses' knowledge, attitudes, experience, and confidence with regard to ADs.|This review completed a systematic synthesis of reported results from three survey studies that focused, respectively, on oncology, critical care, and emergency RNs who were members of various professional nursing organizations.|Our investigation addressed the following research questions: What are the knowledge, attitudes, experience, and confidence of RNs with regard to ADs, and what is the relationship among these study variables? Each study used the Knowledge, Attitudes, and
Medical end-of-life decisions, defined as end-of-life practices with a potential or certain life-shortening effect, precede almost 50% of deaths in Western countries, and receive ample medical-ethical attention. This systematic review aims to detect whether there are differences in the prevalence of medical end-of-life decisions in 'vulnerable' patient groups. In 2009, five major databases were scrutinized for publications containing original data on the prevalence of euthanasia/physician-assisted suicide, life-ending without explicit patient request, intensified symptom alleviation, non-treatment decisions and palliative sedation by social factors (eg age, gender and SES). Heterogeneous findings were pooled using a random effects model. We identified 6377 papers of which 51 papers were selected, involving over 1.09 million patients. Most publications reported the prevalence of non-treatment decisions. The most studied social factors were age and gender. Among patients older than
William S. Breitbard, MD, acting chair at the department of psychiatry and behavioral sciences and chief of psychiatry service at Memorial Sloan-Kettering Cancer Center, discusses how to have an effective end-of-life conversation with a patient.
Key Differences between FQHCs and RHCs Chastity Werner, RHIT, June 13, 2013 FQHCs and RHCs take up a unique niche among physician practices. And that affects compensation and billing.
Improving Care Coordination in Your Practice Susanne Madden, June 12, 2013 Practices are feverishly working to control the rising costs of healthcare - effective care coordination can help.
Refunding Overpayments: Two Options for Medical Practices Ericka L. Adler, June 12, 2013 Medicare and Medicaid providers must return overpayments once identified. Here are two different refund approaches for practices to consider when necessary.
iPad Alternatives for Mobile Physicians Marisa Torrieri, June 11, 2013 As more physicians are seeing the merits of media tablets, the market is expanding, too.
An ethnographic study of palliative care specialists reveals that many of them find dealing with dying patients a gratifying experience. The scant evidence about oncologists on this subject paints a much different picture.
ASCO’s QOPI analysis recently found that less than half of all cancer patients are enrolled in hospice care before their death and of those who are enrolled, one-third are not enrolled until the last week of their lives. In response to this and other findings, ASCO published a new policy and guidelines this week, intended to encourage physicians to initiate open dialogue about palliative care and treatment with patients as soon as they are identified as having incurable cancer.
