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Hospice – Touchy Subject

Hospice Care

Many Americans, don’t want to have to think about not being able to take care of themselves as they become elderly and ailing, but there is a time where this needs to be considered. It seems that it is typical to delay or bury your head in the sand when it comes to matters that involve death and dying, and recent findings till us that even many patients that are terminally ill put off the conversation about end-of-life choices.

One of the largest studies to date on this issue, uncovered that approximately half of the 1,517 patients with metastasized lung cancer who were questioned had actually discussed, within four to seven months of diagnosis, hospice care with their doctor or their healthcare provider. Unfortunately the vast majority of these types of patients do not survive for more than two years.

Hospice is care that focuses on managing pain and emotional and spiritual needs, rather than trying to cure a terminal illness, that can be given in a hospital, at home, or in a specialized facility. But it is the last road taken, meaning that a patient must acknowledge their health status and relinquish hope and control.

It is a practical and compassionate approach for end-stage care. With the probability of the discussion about hospice becoming even lower, this seems especially difficult for some races and elasticities. The study showed, only 49 percent of the African-Americans and 43 percent of Hispanics had the conversation with their doctors, when compared with the 53 percent of Caucasians and 57 percent of Asians. The researchers also said that the longer the terminally ill patient life expectancy was, the less likely the subject of hospice was brought up.

Haiden Huskamp, who is a Harvard Medical School associate professor of healthcare policy and the study’s lead author, said, “Patients who had unrealistic expectations about how long they had to live were much less likely to talk about hospice with their doctor.” Hospice takes on a growing urgency as an estimated 90 million Americans live with dangerous and life-threatening illness everyday and this is considered an emotionally charged issue.

According to a recent report presented by the National Palliative Care Research Center this number is expected to more than double over the next 25 years as the baby boomer generation ages. Researchers from Harvard compiled the files of patients with cancer in California, Iowa, and Alabama, and then surveyed the patients whether a physician or other healthcare provider had recommend hospice care to them, or talked about end-of-life preferences for care with them. This study, which did not go into the reason why this discussion did or did not happen, was funded by the National Cancer Institute and is being published in the Archives of Internal Medicine.

Huskamp’s idea was that these patients who said that they had not discussed or even considered hospice may not have totally understood their prognosis. Or they may be choosing to believe that a better outcome is possible for them. She also stated that, generally, doctors are not very well prepared to handle such delicate and possible touchy conversations with their patients. Although part of this generation graduated from medical school when the end-of-life care was not included in their study curriculum.

Dr. JoAnne Nowak, medical director of the Partners Hospice and Palliative Care Program in Boston, said “You have a lot of doctors out there who were not trained in these conversations about end of life or breaking any kind of unhappy news, whether it’s a prognosis or difficult treatment.” However, this data is slowly changing, as more and more medical schools include some specialty training in this area into their core curriculum.

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