Concise Review for CliniciansPalliative Care and Hospice Programs
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
- a.
- 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
- a.
Correct answers
1. b, 2. a, 3. b, 4. e, 5. d
References (10)
Cancer pain relief and palliative care: report of a WHO Expert Committee
World Health Organ Tech Rep Ser
(1990)The evolution of hospice and palliative medicine
- et al.
Advance directive
Oncol News
(1998 Mar/Apr) Death and Dying in America: Too Much Technology, Too Little Care
(May 1998)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)