Hospice/Palliative Interview

The change which is outlined in this paper relates to how early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management. PICO format question will be used , along with a supportive body of evidence regarding the fact that early onset into a hospice program is helpful with providing end of life pain

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

The World Health Organisation (2010) defines palliative care as: An approach that improves the quality of life of patients and their families facing problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. It is also our duty to support John and his wife`s in their decision for John to die at home, Department of health (2008) patients should have a choice over the care they receive and where.

A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

In contrast to the costs of standard medical care, hospice care provides an alternative that is both cost effective and caring. Unfortunately, it is actually difficult to quantify the cost savings associated with hospice care due to the fact that comparing costs during the last year of life are impacted by the variability in the length of hospice use. A study at Duke University went to extensive lengths to provide a comparison that provided an effective method for accurate comparisons. The comparison showed a reduced average Medicare expenditure of $2,309 per person from the time hospice care was initiated in comparison to the same situation handled through standard medical methods (Taylor, Ostermann, Houtven, Tulsky, & Steinhauser, 2007). The amount of cost savings varied depending on the primary health condition and the

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

According to the National Hospice and Palliative Care Organization, (NHPCO, 2012) in 2011, an estimated 1.65 million patients received services from hospice and an estimated 44.6% of all deaths in the United States were patients under hospice care. In 2001, an estimated 36.6% of cancer patients accessed three of more days of hospice care. The median length of service in 2011 was 19.1 days. 56.4% of hospice patients were female and 43.6% were male. 83.3% of hospice patients were 65 years of age or older, and more than one-third of all hospice patients were 85 years of age or older. 82.8% of hospice patients were white/Caucasian. Patients of minority (non-Caucasian) race accounted for more than one fifth of hospice patients. Today cancer diagnoses account for less than half of all hospice admissions (37.7%). Currently less than 25% of U.S. deaths are now caused by cancer, with the majority of death due to other terminal diseases. The top four non-cancer primary diagnoses for patients admitted to hospice in 2011 were debility, dementia, heart disease, and lung disease (NHPCO, 2012).

The present-day misconception of palliative care possibly comes from the circumstance that palliative care was used interchangeably with hospice care until the 1980s. (Clark & Seymour, 1999). Clark and Seymour (1999) extensively write on the beginnings and evolution of palliative care. They describe the progression of palliative care as a whole and explain the movement from palliative starting out as supplemental care to terminal patients to the concept division of palliative and hospice care. They describe the differences in each and explain why palliative is its own concept that differentiates from hospice care. In 2002, the World Health Organization defined palliative care as “an approach” that increases the quality of life of

Paulus, (2008) discusses in her thesis that patients with chronic diseases need symptom control and pain management but are often referred to palliative care services too late and do not receive the care and support they need. Late decision making reduces patient autonomy; patients may become too unwell to participate in formulating their plan of care (Al-Qurainy, Collis, & Feuer, 2009). In a study carried out by evaluating the notes of patients that had died it was concluded that physicians did not feel confident giving an end of life diagnosis; this can cause a delay in care (Gibbins, McCoubrie, Alexander, Kinzel, & Forbes, 2009). Palliative care in hospitals would improve the quality of end of life care. Paulus (2008) believes it is an

This is recognized to be an issue, and throughout the article the authors provided an understanding of how palliative care and end-of-life care are provided too late for a patient and should be provided at an earlier time in order to bring more comfort to the patients. The authors suggest that when and how end-of-life care is provided should be altered, with nursing ethics in mind, so that patients and nurses may feel better about the care they receive. This source will help my research by providing information on how changing the policies of end-of-life care and palliative care can result in the patient feeling a relief from their suffering and ultimately feeling more comfortable. This will also help my argument in how altering the current policies and focusing on providing better end-of-life care can lead to the diminishment of physician-assisted

According to the Agency for Healthcare Research and Quality (AHRQ) despite the evidence that consistently indicates that palliative care and provision of access to hospice is essential to end-of-life comfort and quality of life in the final stages of terminal illness, it is still not used effectively or sufficiently (2012). In fact, Ctarlson et al., (2010) determined that in spite of the fact that there has been a 41% increase in the total number of hospice service providers in the United States since 2000, that at least 60% of terminally ill Americans still die without the benefit of hospice services. This is because a variety of factors can create an availability gap, or make it increasingly difficult for individuals to access hospice care. These factors generally include: geography, race, age, and socioeconomic capital (Silveira 2011). Each of these factors can be individually examined, as they relate to care accessibility.

To identify the palliative care needs, the research presented the patients with the Short Form 36 (SF36), using the Hospital and Anxiety and Depression Questionnaire (HADS). The patients and significant others (n=35), were separated for the researcher to conduct an unstructured interview. Following the questionnaire, the multiprofessional clinical team conducted a focus group debate (n=18).

Therefore, content analysis was performed on Palliative Care and oncologic visit notes. Consequently, there were 151 patients enrolled at Massachusetts general Hospital from Boston, the oncology clinic. These patients were just being diagnosed with metastatic non– small cell lung cancer. The Eastern Cooperative Oncology Group had patient’s eligibility who were diagnosed within 8 weeks with the achievement level of 0 to 2, as they completed their questionnaire in English. However, the participants were randomly allocated as 1:1 ratio to have early Palliative Care cohesively with ordinary oncologic care or with alone ordinary oncologic care. The Palliative Care clinicians were conducting the visits which was flexible and suitable for the individual patients. The documentation of content was done by Palliative Care clinicians of clinical encounter in the electronic health record after each visit. The study has been approved by the institutional review board of the “Dana-Farber/Harvard Cancer

Hospice is a component of palliative care. A person does not necessarily have to be dying in order to see a palliative care specialist. This is where the service is often underutilized in the hospital. In the 18 months I have been a nurse, I have cared for many patients with chronic illnesses who have dealt with symptoms that have severely impacted their quality of life. Most of the time, it seems as though the patient’s care providers are interested in treating the patient’s acute problems. My experience has been that the symptoms are often overlooked or are being treated in a manner that is to the dissatisfaction and discomfort of the patient.

The medical records of 246 in-hospital cancer deaths were reviewed to explore the relation between palliative care (PC) timing