Physician-Patient Communication Key to Thoughtful Hospice Use

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Physician Patient Communication Hospice CareEnd-of-life decisions are some of the hardest we’ll ever make. Society will continue to grapple with these issues, of course, but it’s good to see that the recognition of hospice care is growing.

A recent study of Medicare records found that twice as many elderly people died in hospice care as in a hospital or nursing home than a decade ago. However, intensive-care use, hospitalization and the rate of healthcare transitions increased in the last month of life before patients entered hospice.

Despite the overall increase in hospice use, it is often used very late in the process (more than a quarter of the hospice admissions in 2009 was for three days or less) or after an intensive-care stay (40% of those late referrals). As those in the hospice industry know, this negates many benefits, such as controlling pain and addressing the physical, emotional, social and spiritual needs of dying patients and their families.

As is often the case, better communication is the answer to more thoughtful use of hospice. The study was published in The Journal of the American Medical Association with an editorial calling for an end to the aggressive intensive care and hospitalization at the end of life by improving communication between patients and physicians to determine what patients want.

Physicians also should consider a threshold of likely benefit and life expectancy for an ICU admission, say the editorial’s authors, Dr. Grace Jenq of the Yale School of Medicine and Dr. Mary Tinetti of the Yale School of Public Health. They note that offering hospice care earlier in the process is essential to reducing unnecessary care overall and that studies involving advanced cancer patients show continued communication gaps between patients and clinicians concerning end-of-life preferences.

Life is a continuum, and this study shows that we still have a ways to go to show that hospice is a logical and natural part of the continuum for many people.

Learn more about how to improve communication and patient care within a hospice agency. Stay up to date with our latest news from the hospice industry by subscribing to the McKesson Homecare Talk blog or liking us on Facebook.

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