The Benefits of Early Referral of Patients into a Hospice Program

I. Main point #1 According to StatisticBrain.com, “55% of terminally ill patients die in 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

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.

Although nurses have their experience to guide their practice, as the health professional most involved with the client at the end of life, there is a need for review of current assessment tools and management strategies to ensure the care given is evidence based and best practice.

Care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. Aggressive methods of pain control may be used. Hospice programs generally are home-based, but they sometimes provide services away from home in freestanding facilities, in nursing homes, or within hospitals. The philosophy of hospice is to provide support for the patient's

In almost every case of a terminal disease, pain is intolerable and seeing someone in such agony is heartbreaking. For example, Brittany Maynard, a 29 year old brain cancer patient who had to move to Oregon so she can avail of the Death with Dignity act. “Maynard knew that her form of brain cancer would be excruciating. She would endure swelling of the brain that would very likely cause seizures, painful headaches and the gradual loss of bodily function. Doctors know that for about 5 percent of the population, no amount of morphine can block the agonizing pain the terminally ill endure” (EDITORIAL: Dying with dignity). Palliative care can often be provided for the dying patients and alleviating pain to provide comfort for the dying has always been the priority. “Palliative care focuses on relieving the symptoms, particularly the pain, of incurable illness.” (Palliative Care) But, in relieving pain through the prescribed medications there are also side effects that are caused by the prescribed pain suppressors and two examples will be lethargy and it compromises breathing. In most cases the effectivity of the pain medication may no longer alleviate the pain. If a patient will be in such agony for the remaining days or weeks the quality of life is no longer present. The agony of pain prevents a patient from performing even just the bodily functions.

Thesis: Terminally ill patients suffering from unresolved palliative care requests physician assisted suicide in a quickened death, refusing to help patients from suffering may cause an extreme amount of unbearable pain.

Barriers to effective pain management exist. These barriers include: religious belief, poor practice by doctors, patient fear, and incorrect doses of medication. The issues of the barriers are being addressed with great efforts to remove them. Removing these barriers is the answer to full pain management on the opposing side to physician assisted suicide (Balch, Waters 7). The majority of patients requesting assisted suicide due to pain decided against suicide after their pain was treated properly. “...the availability of assisted suicide may lead to a decrease in or failure to increase the availability of pain management…” (Harned 515).

Another claim is that increase in hospice care or palliative care will result in fewer requests of PAS (Boer 2007). Hospice focuses on the care of the terminally ill, while palliative is medical care focuses on relieving pain and unnecessary suffering. Palliative care can address most, but not all, end of life pain (Quill 2012). 95.1% of individuals who request PAS currently receive hospice care (Campbell). Therefore, hospice does not affect the desire for

Pain is a universal human experience and it is subjective. It is a major concern for those with cancer. One of the priorities of hospice is to provide comfort and a pain free death. It is however a concern that many people are still dying with uncontrolled pain. We are interested in hospice and pain management because hospice is known to be a place of comfort where individuals are provided with relief and allowed to die peacefully without pain. The majority of patients in the hospice settings are older adults with advanced cancer. Our goal is to create an intervention that will appropriately deal with the poor pain management experienced by many in hospice care. In order to help us with this task, four articles have been reviewed with regards to hospice and pain management.

Palliative care for end of life patients has many characteristics, but management of moderate to severe pain is among the most important considerations for patients, family members and healthcare providers. In order to provide complete pain control nurses must accurately assess pain symptoms and non-pharmacologic and pharmacologic measures must be appropriately implemented. Healthcare providers must also be knowledgeable of potential barriers to pain therapy and how to address such barriers in order to provide the most patient-specific and effective treatment possible.

Pain management became a new area of study and this led to the development of modern hospice and palliative care services. The anesthesiologist, Dr. John Bonica, dedicated his career to understanding one’s perception of pain and the methods available to adequately treat pain (Seymour, Clark, & Winslow, 2005). In 1947, Dr. Bonica established the first 24 hour pain service at Tacoma General Hospital and by 1960 pain service specialties had expanded to the University of Washington and then Memorial Sloan Kettering Cancer Center (MSKCC) in 1975 (Seymour et al.,

In 2003, the American Nurses’ Association published a position statement regarding “Pain Management and Control of Distressing Symptoms in Dying Patients.” The organization states:

Pain is a subjective and personal experience, one of the most distressing symptom that people may encounter at the end-of life, and its many consequences impact quality of life (QOL). The World Health Organization (WHO) has recognized that an estimated 5.5 billion people worldwide and 5.5 million terminally ill cancer patients who either have minimal or no access to controlled medicines or lack of inadequate treatment for moderate to severe pain management (WHO, 2012). In addition, the National Institute of Health (NIH) has identified that nationwide an estimated 23.4 million adults suffer

The case study based on the palliative patient Mrs. Mavis looks at issues both the family and the patient are dealing with in regards to the end of life treatment Mrs. Mavis is receiving. Mrs. Mavis is a palliative patient, currently unconscious, who is dying and only wants comfort measures within her nursing care. This was made clear through her advanced care directive, which was made weeks before beginning to receive her end of life care. Mrs. Mavis’ comfort measures include pain relief, hygiene and keeping her comfortable. Mrs. Mavis’ family want her to have fluids and medications to help improve her health. They also want oxygen and pain relief to help with her breathing. Issues such as educating and supporting the family, pain management, the effectiveness of having an advanced care directive and pain assessment will be evaluated to determine the best effective interventions for Mrs. Mavis and her families care. Interventions that will be discussed through-out this essay include the use of analgesia medication, the use of subcutaneous injections and syringe drivers, emotional support for the family, effective communication, educating the family on Mrs. Mavis’ wishes and the importance of having an advanced care directive. These interventions will be evaluated to ensure they are the best practice for Mrs. Mavis’ care.