Central PA Medicine - Summer 2017 - 16

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90 percent of people say that talking about their
end-of-life care is important...yet only 27 percent
actually do so.
In addition, 80 percent of people say that if
seriously ill, they would want to talk to their
doctor about wishes toward the end but only
seven percent report having had this conversation.
And 82 percent of people say it's important to
put their goals in writing while only 23 percent
actually do so.
Isn't it time for doctors, along with patients and
their families, to expand their conversations to
include not only how to live, but also how to die?

Hospice Today

Since modern hospice care in America began Physicians and Hospice
in the early '70s, the amount of patients receiving
I think the best physician is the one who has
care has grown steadily each year. In its latest the providence to tell to the patients according
findings, The National Hospice and Palliative to his knowledge the present situation, what has
Care Organization (NHPCO) reports that 1.7 happened before, and what is going to happen in
million patients receive hospice care annually the future. - Hippocrates
(double the figure from year 2000) from approximately 6,000 hospice agencies. Medicare,
Given an uncertain future, family dynamics,
which pays nearly 90 percent of all hospice claims, and a dizzying array of medical technology,
now funds 1.8 billion dollars annually in hospice critically ill patients, along with loved ones, look
reimbursements, up 52 percent from eight years to the doctor for guidance. Some physicians may
prior. Unplanned hospital readmissions, excessive see death as a personal or professional admission of
emergency room visits, overuse of services, and giving up or having failed, and choose unnecessary
costs have all been reduced.
efforts to prolong life.
Despite the positive trends, a number of
challenges continue. One major concern is that
the average length of stay in hospice care remains
severely underutilized. NHPCO reports that one
in three hospice patients receive care for seven days
or less (half for 17 days or less), limiting patients
and their families the many medical, spiritual and
support benefits only a viable, stabilized hospice
program can provide.

Others are unsure of medical procedures and
perceptions. According to a recent survey by
The Journal of Palliative Medicine, 84 percent of
participants were unable to identify appropriate
hospice diagnoses. Difficulty of predicting death
to within six months was cited by 37 percent as
the foremost barrier to referral. In addition, a
quarter expressed concern that patients or families
would negatively interpret hospice referral as a
cost-saving measure.

conversations. Nearly half reported that they
frequently or sometimes feel unsure of what to
say, and less than one-third reported having had
any formal training specifically on talking with
patients and their families about end-of-life care.

Hospice and "The Conversation"

There are a number of resources available to
improve physician communications skills and
confidence in end-of-life situations. Many medical
institutions offer training in this area, and online
resources are available, as well.

Hospice care specialists can be a tremendous
asset for physicians seeking to communicate
more effectively in end-of-life situations. Deb
Klinger is the director of Homeland Hospice, a
Harrisburg-based nonprofit organization that
serves 13 counties in central PA.
"Some doctors have personal experiences that
make them more open to have 'the conversation'
early in the process," she says. "Others remain a
little hesitant - our society doesn't want to give
up on life...we're all immortal, right?

While it may be true that some physicians
"Homeland has an ongoing outreach program.
and hospitals don't refer terminally ill patients for
Still others find it difficult to engage in end-of- Our clinical liaisons can assist when the treatment
hospice care until the very end due to loss of reim- life discussions. In 2016, The John A. Hartford focus must change from curative to comfort.
bursement, a major impact on length of service Foundation released findings from a national poll Every day is a gift, and we can bring happiness,
is that adequate planning and communication exploring the views of primary care and specialist acceptance and peace to our patients and their
regarding the patient's end-of-life treatment is not physicians about end-of-life and advance care loved ones."
addressed in a timely manner, if at all.
planning conversations with patients. Almost all
surveyed agreed these discussions are important. Personal Note from the Author
The survey also identified obstacles that prevent
My mother Jane died several years ago at 86.
physicians from engaging in these sensitive I am one of three children.
16 Summer 2017 Central PA Medicine


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