Hospice Care Going Unused
Many terminal patients don't take full advantage of possible aid
 (HealthDay News) -- Although many people nearing life's end can choose how they'll spend their final days, experts say that far too few terminally ill people are taking advantage of services aimed at maintaining dignity and easing pain at the end of life.
Terminally ill people often view it as, 'OK, someone is telling me to crawl into my bed and die,' " Dr. Gail Gazelle, an assistant clinical professor of medicine at Harvard Medical School , told HealthDay . The reality, she said, is that many people confined to hospitals lead full, mobile and high-quality lives for months, while hospice care is underused in the United States . Gazelle authored an article on the topic in the New England Journal of Medicine .
Hospice is a type of care designed to comfort and support people who are dying and their families, says the Hospice Foundation of America. Patients are referred to hospice when their life expectancy is about six months or less.
Most hospice services take place within a person's home, whether that's a nursing home, an assisted living facility or a private residence, the foundation explains. A team of specially trained professionals helps manage symptoms of the person's disease, with special emphasis on managing pain. Hospice also helps patients and families deal with the emotional, social and spiritual impact of the disease.
Though hospice care began as a grassroots movement in the United States some 30 years ago, it is now considered part of mainstream medicine, Gazelle wrote.
Hospice was added as a Medicare benefit in 1982, according to the AARP Public Policy Institute. Many private health insurers also offer hospice benefits, according to the Hospice Foundation.
The National Hospice and Palliative Care Organization estimates that 36 percent of all people who died in the United States in 2006 were, at the time, under the care of a hospice program.
Yet hospice remains widely misunderstood. Although care can be provided for at least six months, the average length of hospice service is only 26 days, and a third of patients are referred during the last week of life, Gazelle reported.
And some barriers to hospice care exist, including a lack of coverage for certain palliative treatments, said Dr. Alexi Wright, a fellow with the Center for Psychosocial Oncology and Palliative Care Research at Dana-Farber Cancer Institute.
In a separate article in the journal, Wright and a colleague recounted the story of 64-year-old Joanne Doolin, a mother of three who spent her last two years of life battling colon cancer.
Had Doolin entered hospice care, she would have been forced to give up intravenous feeding and would have died within days, Wright told HealthDay . Instead, she continued intravenous feeding and hospital-based chemotherapy, enabling her to live long enough to see her daughter get married.
When people enter hospice care, they "often have to give up medicines that are helping to support them, make them feel better, helping them live longer," she said. Wright said she favors a system of "open access" that would take people's individual needs into account.
For anyone considering hospice care, the National Hospice and Palliative Care Organization suggests:
- Having an advance directive in place that authorizes a trusted individual to make decisions on the patient's behalf if he or she is unable to do so.
- Gathering as much information as possible about services provided by whatever hospice facilities are available in the community.
- Making sure the patient understands how hospice services are paid for.
- Encouraging the person who would be entering hospice to share his or her thoughts, concerns and choices with family, friends and all doctors.
On the Web
To learn more about selecting a hospice facility, visit the Hospice Foundation of America.
SOURCES:
HealthDay News ; Gail Gazelle, M.D., assistant clinical professor of medicine, Harvard Medical School, Boston; Alexi Wright, M.D., fellow, Center for Psychosocial Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston; July 26, 2007, New England Journal of Medicine ; Hospice Foundation of America (www.hospicefoundation.org); AARP Public Policy Institute (www.aarp.org); National Hospice and Palliative Care Organization (www.nhpco.org and www.caringinfo.org)
Author:
Karen Pallarito
Publication Date:
Aug. 31, 2008
Copyright © 2008 ScoutNews, LLC. All rights reserved.
|
