Difficult, but Necessary, Conversations about Death

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Difficult, but Necessary, Conversations about Death

A new study shows that pain and depression among hospice patients increased between 1998 and 2010. It remains to be seen whether the increase can be attributed to physicians not knowing when further treatment is futile, a greater awareness among a patient’s family members of pain and suffering or some combination of factors.

What remains clear, however, is that conversations about death and dying – between physicians and patients as well as between patients and their families – must become an integral part of the care discussion. It also points to the need for hospice organizations to lead the discussion in their communities.

The observational study, published February 3 in the Annals of Internal Medicine, surveyed 7,204 participants/patients who died during the study period and their families. Between 1998 and 2010, the prevalence of pain increased 12% to nearly 61%. During the same time period, symptoms of depression increased by 26% and periodic confusion rose by 31%.

“Despite national efforts to improve end-of-life care, proxy reports of pain and other alarming symptoms in the last year of life increased from 1998 to 2010,” concludes the study abstract, “Symptom Trends in the Last Year of Life From 1998 to 2010: A Cohort Study.”

Respecting the dignity and wishes of those at life’s end should be a pillar of modern healthcare. I’ve shared information about a Journal of the American Medical Association investigation that showed hospice patients had fewer hospitalizations, fewer invasive procedures, less time spent in intensive care and a far greater chance of dying at home rather than at a care facility. At the same time, spending among hospice patients was 12% less that a nonhospice group.

Home health organizations intrinsically respect the dignity of patients by helping patients recover from hospitalizations, regain mobility and continue to live independently. Hospices, too, are a logical, natural and final extension of the care process.

Each of you has an important story to tell in your community. Are you telling it to anyone who will listen, from patients and physicians to your referral partners? It’s not just good for business – it’s good for the patients you serve.

Discover more ways to improve your hospice organization and provide better patient care by visiting the McKesson Homecare Talk Resources Center.

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