Elsevier

Mayo Clinic Proceedings

Volume 75, Issue 2, February 2000, Pages 181-184
Mayo Clinic Proceedings

Concise Review for Clinicians
Palliative Care and Hospice Programs

https://doi.org/10.4065/75.2.181Get rights and content

Palliative care and hospice programs are points on the continuum of comprehensive patient care. Unfortunately, provision of care for terminally ill patients is suboptimal. There are many new approaches to improving the skills of all physicians to fulfill the needs of patients, including better education for house staff, “train-the-trainers” programs for physicians in practice, research into methods of symptom control, and better access to established hospice programs. This review covers the history, current status, and practical suggestions for improving palliative care and hospice programs in primary care settings.

Section snippets

History

Dame Cecily Saunders is credited with starting the first formal hospice program at St Christopher's in London in 1967. Florence S. Wald developed the first US home-based hospice program in 1977. Dr Elizabeth Kubler-Ross raised awareness of the steps of death and dying that patients experience and advocated the home, rather than the intensive care unit, as the place for a “good death.”2

Since 1982, Congress has authorized a Medicare-approved hospice benefit. Many private insurers provide for some

Palliative Medical Practice

Palliative medicine has become a subspecialty within American medicine. Specialists in palliative care and hospice care should provide the leadership and quality research needed to advance this field.8 However, there is a critical need for all physicians to become more skilled at meeting the palliative care needs of their patients, rather than relying on palliative care specialists and hospice groups.1,9,10

Primary care physicians understand that patients' needs are not only physical but also

Symptom Control

Symptoms that require medical intervention near the end of life include pain (75%), dyspnea (70%), anorexia-cachexia (85%), constipation (65%), nausea-vomiting (68%), neurologic changes (10%), and psychological distress (50%). Some of these common symptoms and approaches to their relief are listed in Table 1. Practical references for palliative symptom control include the Primer of Palliative Care from the American Academy of Hospice and Palliative Medicine (Intellicard), Symptom Management

Questions About Palliative Care

  • 1.

    Which one of the following life expectancies is a criterion for patient coverage in the Medicare hospice program?

    • a.

      1 year

    • b.

      6 months

    • c.

      3 years

    • d.

      2 years

    • e.

      18 months

  • 2.

    Which one of the following is true regarding the findings of SUPPORT?

    • a.

      Too many patients die without adequate symptom control

    • b.

      Most patients execute advanced directives

    • c.

      Palliative care units should be established in hospitals

    • d.

      Patients want aggressive care

    • e.

      Feedback to physicians about patient prognosis optimizes the management of

Correct answers

1. b, 2. a, 3. b, 4. e, 5. d

References (10)

  • World Health Organization

    Cancer pain relief and palliative care: report of a WHO Expert Committee

    World Health Organ Tech Rep Ser

    (1990)
  • WB Forman

    The evolution of hospice and palliative medicine

  • JJ Lynch et al.

    Advance directive

    Oncol News

    (1998 Mar/Apr)
  • Death and Dying in America: Too Much Technology, Too Little Care

    (May 1998)
  • SUPPORT Principal Investigators

    A controlled trial to improve care for seriously ill hospitalized patients: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT)

    JAMA

    (1995)
There are more references available in the full text version of this article.

Cited by (0)

View full text