News Media Clips/Blogs
A major shift in end-of-life care is occurring in our health care system today and a national dialogue is taking place about it in the media.
To help you stay informed, the articles and videos below are a sampling of the discussion taking place in the media. Check back often, as we’ll continue to add items as they occur.
Please feel free to send us an email at hospiceinfo@providence.org.
*Information is being provided as a resource service only. Providence Hospice and Palliative Care Washington does not endorse or refute findings and opinions presented.
Headlines of Interest:
Discussions About End-of-Life Care Between Physicians and Terminally Ill Cancer Patients Often Delayed Too Long
Medical News Today - February 12, 2012
"The vast majority of patients with incurable lung or colorectal cancer talk with a physician about their options for care at the end of life, but often not until late in the course of their illness...
And the doctor who shares in the end-of-life care talk is often a hospital physician, rather than an oncologist who has treated the patient for much of his or her illness.
Together, these circumstances may deprive patients of the opportunity for extended reflection and deliberation that would have been possible months earlier, when the conversation also could have occurred under less trying and hectic conditions, the authors suggest."
The complete article is available here: http://www.medicalnewstoday.com/releases/241449.php
Opportunities and Challenges of Palliative Care in the ICU
Journal of Palliative Medicine: Vol 15, Num 2; January 31, 2012
"The importance and potential benefits of palliative care to ease suffering and improve quality of life for patients being treated in hospital intensive care units (ICUs) has received increasing recognition but is not without significant challenges, as discussed in a Roundtable discussion in Journal of Palliative Medicine, a peer-reviewed journal published by Mary Ann Liebert, Inc.
"It seems clear that palliative care in the ICU improves the quality of care for both patients and their families. I suspect this will become standard of care in all hospitals in coming years," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine, and Provost, Institute for Palliative Medicine at San Diego Hospice.
Read the entire Roundtable Discussion at http://online.liebertpub.com/doi/pdf/10.1089/jpm.2011.9599
Why the Family Meeting is Important
Jeffrey Alderman, MD - January 24, 2012
"Every day, nearly 12,000 Americans are admitted to intensive care units for any number of life threatening conditions. In the ICU, doctors and nurses work tirelessly to help patients breathe, sustain blood pressure, and eliminate infections. Through years of training, we learn to ‘fix’ many medical problems – and we derive tremendous satisfaction when previously ill patients ‘get better’ because of our efforts."
"Yet missing from training is how to handle the “what-ifs.” What if the lungs and heart do not recover? What if the infection cannot be treated? What if, despite state-of-the-art, intensive, aggressive therapies, our patients do not ‘get better?’"
Read the entire article at http://www.kevinmd.com/blog/2012/01/family-meeting-important.html
National Hospice and Palliative Care Organization releases annual report on "Facts
and Figures: Hospice Care in America"
NHPCO, January 11, 2012
"There are no better providers more skilled at providing palliative care at the
end of life than hospice professionals and the dying deserve the best care that
our society can offer," [J. Donald Schumacher, NHPCO president and CEO] emphasized. The report reveals that "the number of patients served remains fairly constant at 1.58 million in 2010 (a slight rise from1.56 million served in 2009).
Yet a statistic of concern to hospice and palliative care professionals is the drop
in both median and average length of service".
Two new additions to the new edition of the report include sections looking at
hospice care within the Medicare population and within the nursing home.
The entire article and the report is available on NHPCO's website, at: http://www.nhpco.org/i4a/pages/index.cfm?pageid=6056
Early Palliative Care Beneficial in Metastatic Non Small Cell Lung Cancer
Journal of Clinical Oncology, December 27, 2011
This latest article confirms observations that aggressive treatment does not
prolong survival in metastatic solid tumors, and hospice and palliative care
do not shorten survival, notes Craig C. Earle, MD, from the Odette Cancer
Centre in Toronto, Canada, in an accompanying editorial.
"Oncologists need to accept the possibility that our patients might be better off if
we do not try to do everything ourselves," he says. "It takes a village to help our
patients through this journey. The quality of end-of-life care can be better when we
take a team-based approach to managing incurable cancer right from the start."
"This is not a paper about end-of-life care. This is not a paper about palliative care instead of chemotherapy," he said. "It's about adding palliative care specialist interventions to standard chemotherapy. It clearly made life better. It made it longer
and helped patients make much better decisions at the end of life." http://www.medscape.com/viewarticle/756174
http://jco.ascopubs.org/content/early/2011/12/20/JCO.2011.40.1414.full.pdf
Hospital Palliative Care Programs Raise Grade to B in New Report Card on Access
JAMA, Dec. 7, 2011
"A recent survey that graded the 50 states on access to palliative care bumped the United States up a grade, to a B from a C in 2008. Despite the rapid growth of hospital-based palliative care programs, the survey nonetheless reports ongoing barriers to access: too few trained professionals, knowledge gaps in symptom relief, and the need for new reimbursement models.
The 2011 survey, carried out by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) at the Mount Sinai School of Medicine, both in New York City, examined data taken primarily from the American Hospital Association Annual Survey Database for 2009. Of the 2489 hospitals with 50 or more beds surveyed, 63% had palliative care programs. Of hospitals with more than 300 beds, 85% had palliative care teams (http://www.capc.org/reportcard/)."
http://jama.ama-assn.org/content/306/21/2313.full
Poll Reveals Challenges of Providing End-of-Life Care
WebMD, Nov. 16, 2011
"Though doctors nearly universally agree that helping patients die without pain is a more important goal than doing everything possible to prolong their lives, many say it can be tough to talk to patients about palliative care, a new poll shows.
The poll results were released by the National Journal and The Regence Foundation, the nonprofit arm of the Regence health insurance company. The results reveal some of the struggles doctors face caring for patients who are at life's end."
http://www.webmd.com/palliative-care/news/20111116/poll-reveals-challenges-of-providing-end-of-life-care
Medical field looks to comfort the ill
Journal Sentinel, Oct. 31, 2011
"Diane Meier, a professor at Mount Sinai School of Medicine in New York City, is considered the nation’s foremost expert on palliative care. Meier, director of the Center to Advance Palliative Care, is the author of "Palliative Care: Transforming the Care of Serious Illness," the first comprehensive book on the new field. She also has contributed to more than 20 books on geriatrics and palliative care." This article provides a palliative care Q & A.
http://www.jsonline.com/features/health/medical-field-looks-to-comfort-the-ill-132941128.html
The promise and pitfalls of palliative care
Los Angeles Times, Oct. 24, 2011
"What if a new medication for severely ill patients had no role in curing them but made them feel much better despite being sick? Let's say this elixir were found to decrease the pain and nausea of cancer patients, improve the sleep and energy of heart failure patients, prolong the lives of people with kidney failure, drive down healthcare expenditures and ease the burdens of caregivers?
Those are the promises of a fledgling medical specialty called palliative care — not a new drug but a new way of treating patients who are living, often for years, with acute or chronic Illnesses that are life-threatening."
http://www.latimes.com/health/la-he-palliative-care-20111024,0,4249424.story
Hospital-based palliative care rises 19%
American Medical Association, Oct. 17, 2011
"The nation has improved its overall grade on providing hospital-based palliative care to a B, up from a C in 2008.
The higher grade is due to a 19% rise in the number of hospitals with palliative care teams since 2008, according to a report released in October. The number of 50-plus bed hospitals with palliative care teams has nearly tripled since 2000 to 63%, said the research conducted by the Center to Advance Palliative Care, a New York nonprofit that helps hospitals set up palliative care operations. Eighty-five percent of hospitals with 300 beds or more have such teams in place, the report said.
Palliative care teams are composed of physicians, nurses, social workers and chaplains who help patients with serious or life-threatening illnesses by treating pain and other symptoms, finding the best setting for the patient after discharge, and alleviating psychosocial and family burdens."
http://www.ama-assn.org/amednews/2011/10/17/prsc1017.htm
Advance Directives Related To Use Of Palliative Care, Lower Medicare End-Of-Life Spending
Medical News Today, Oct. 5, 2011
"Advance directives do have an impact on health care at the end of life, especially in regions of the country with high spending on end-of-life care, according to a University of Michigan study.
People who had completed advance directives stating their preferences for care were less likely to die in a hospital and more likely to receive palliative hospice care than similar decedents without advance directives.
"Advance directives may help patients get the care they want if they prefer less aggressive care at the end of life, while also providing cost savings to the Medicare program, particularly in higher-spending regions of the country," said Lauren Hersch Nicholas, a U-M health economist who is the lead author of the study."
http://www.medicalnewstoday.com/releases/235496.php
Survival Rates Unaffected By End-Of-Life Discussions
Medical News Today, Sept. 30, 2011
"Discussing and documenting patients' preferences for care at the end of life does not cause them any harm, contrary to recent claims. A new study published in the Journal of Hospital Medicine found that patients who talk with their physicians about end-of-life care and have an advance directive in their medical record have similar survival rates as patients who do not have these discussions and documents.
"Our findings are reassuring. They support health care providers, who can initiate these discussions, and policy makers, who seek to reimburse these time consuming discussions," said lead researcher Stacy M. Fischer, MD of the University of Colorado School of Medicine. "Most importantly, our findings are reassuring for patients and families who desire these discussions with their health care providers.""
http://www.medicalnewstoday.com/releases/235199.php
Hospitalists See Value in Palliative Care
The Hospitalist, Sept. 7, 2011
"Hospitals that are looking to improve the systems of care, hospitals that are looking to be more cutting-edge, looking to be adopters of new models of care are going to pursue both hospital medicine and palliative care," Dr. Pantilat says. "That is another way that hospitalists can demonstrate added value."
http://www.the-hospitalist.org/details/article/1338921/Hospitalists_See_Value_in_Palliative_Care.html
Palliative Care Extends Life, Study Finds
The New York Times, Aug. 18, 2011
In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.
http://www.nytimes.com/2010/08/19/health/19care.html?_r=1&emc=tnt&tntemail1=y
From Healing To Hospice: UB Social Work Researcher Adding To The Shift Toward A Good And Compassionate Death
University at Buffalo, July 27, 2011
University at Buffalo School of Social Work Professor Deborah P. Waldrop has seen people die. Too often, their lives have ended in pain and despair, spending their final days in an alienating institutional environment, just another patient in an impersonal progression that leads to what she calls "reciprocal suffering" for families who also watch their loved ones die.
There is another way. In the decades and multiple settings Waldrop has worked with terminal patients, she has seen a growing emphasis on factors that contribute to a "good death." People can make that life transition in a home that has sustained them for many years, surrounded by the people who have given their lives meaning. "Comfort" can be the defining goal of a death without pain and suffering.
http://www.medicalnewstoday.com/releases/231785.php
NEW POLL: Pacific NW More Supportive of End-of-Life Care Options Than Other Americans
PR Newswire, July 6, 2011
"The Northwest is the region of the country that has grappled most directly with the complex and emotional issues surrounding care for people at the end of life," said National Journal editorial director Ronald Brownstein. "And this survey shows that most people in these states are comfortable with an approach that emphasizes not just the duration, but also the quality, of life - though they share the concerns we've seen nationally about cost, information and control at this difficult and vulnerable juncture for families."
http://www.prnewswire.com/news-releases/new-poll--pacific-nw-more-supportive-of-end-of-life-care-options-than-other-americans-125070089.html
Increasing Palliative Care Awareness - the 2011 CAPC Public Opinion Research
Pallimed (A Hospice & Palliative Medicine Blog), June 29, 2011
Palliative Care still befuddles many people when they first hear the term. Even after seeing it people may feel like the many blind scientists touching different parts of an elephant. Historically we have described to people what palliative care is on our terms as the experts who provide it. Looking at many organizations definition of palliative care they have not been made based on public opinion and understanding.
The Center to Advance Palliative Care (CAPC) with support from the American Cancer Society Action Network commissioned a study of public opinions on palliative care, but now the question is what can we do with this new information.
http://www.pallimed.org/2011/06/increasing-palliative-care-awareness.html
Law on End-of-Life Care Rankles Doctors
The New York Times, June 6, 2011
I shouldn’t be surprised when doctors object to laws telling them how to practice medicine, as does New York State’s new Palliative Care Information Act — not surprised, but in this instance, distressed.
Vehemently opposed by the Medical Society of the State of New York, the law passed last summer by a two-thirds majority of the Legislature and took effect in February. The legislation was written in collaboration with Compassion and Choices of New York, an organization that advocates for informed choices and greater physical and emotional comfort at the end of life. .
http://www.nytimes.com/2011/06/07/health/07brody.html?_r=1&ref=hospicecare
In My Time of Dying: An In-depth Look at End-of-Life Conversations
KBTC Documentaries - April 21, 2011
In My Time of Dying explores the way we approach the end of life in America. Medical experts and spiritual leaders are woven together with intimate portraits of people facing imminent death. The result is a unique and important conversation about how we meet death, how we support our loved ones in their time of dying, how we cultivate hope in these times, and how to engage in conversations.
(http://video.kbtc.org/video/1892693338/# )
Engineering the end: How planning for loss helped a family through it
CNN.com, CNN Health - April 18, 2011
"Some doctors indulge themselves and their patients into thinking that over an endless timeline, with unlimited finances, humanity's losing streak against death can be snapped. But every gambler knows the house always wins."
(http://www.cnn.com/2011/HEALTH/04/16/preparing.for.death/index.html)
Palliative care prolongs life, reduces suffering
USA Today, Your Life - February 22, 2011
"Teams that provide palliative care focus on talking to patients, trying to understand people's values and tailor care to the patients' goals, Cooney says.
These teams — which often include psychologists, social workers, pharmacists, nutritionists and chaplains — also coordinate treatment, which can be especially important if people are being seen at more than one center, says Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
The teams also support caregivers, who have a critical role in patients' health."
(http://yourlife.usatoday.com/health/medical/treatments/story/2011/02/Palliative-care-prolongs-life-reduces-suffering/44046292/1)
More People Choosing Hospice at Life's End
U.S. New's HealthDay - January 28, 2011
"Hospice has had to overcome many myths and ill-conceived notions on its way to gaining wider acceptance from the public.
But one notion that patients and their families still struggle with is the idea that choosing hospice means the person is "giving up." People who go into hospice are free to leave at any time, if their symptoms improve or they decide to pursue a new curative treatment, Pacurar said.
"It's not about giving up," she said. "It's about regaining control of your life at this time when chaos is reigning."'
(http://health.usnews.com/health-news/managing-your-healthcare/healthcare/articles/2011/01/28/more-people-choosing-hospice-at-lifes-end?PageNr=1)
Facing Death: How far would you go to sustain the life of someone you love, or your own?
PBS Frontline - November 10, 2010
"There are clinical situations where the odds are so overwhelming that someone can['t] survive the hospitalization in a condition that they would find acceptable, then using this technology doesn't make sense," says Dr. Judith Nelson, an ICU doctor at Mount Sinai. "And yet, in my clinical experience, for almost everybody involved, it feels much more difficult to stop something that's already been started." But, according to Dr. Nelson: "Nobody wants to die. And at the same time, nobody wants to die badly. And that is my job. My job is to try to prevent people from dying if there's a possible way to do it that will preserve a quality of life that's acceptable to them, but if they can't go on, to try to make the death a good death."
(http://www.pbs.org/wgbh/pages/frontline/facing-death/)
Letting Go: What should medicine do when it can’t save your life?
The New Yorker - August 2, 2010
Atul Gawande M.D., Associate Professor of Surgery at Harvard Medical School and Associate Professor in the Department of Health Policy and Management at the Harvard School of Public Health and author of The Checklist Manifesto.
“Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left… Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.”
(http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=all)
Guidance on New Hospice Benefits for Terminally Ill Children Hailed by Hospice and Palliative Care Community
PRNewswire-USNewswire – Sept. 13, 2010
“The families of dying children who are covered under Medicaid or the Medicaid expansion Children's Health Insurance Program (CHIP) will no longer face the choice of stopping curative treatments in order for their terminally ill child to receive quality end-of-life care from hospice.”
(http://www.prnewswire.com/news-releases/guidance-on-new-hospice-benefits-for-terminally-ill-children-hailed-by-hospice-and-palliative-care-community-102767944.html)
Early Palliative Care for Patients with Metastatic Non Small Cell Lung Cancer
The New England Journal of Medicine - August 19, 2010
Temel, et.al
“Among patients with metastatic non–small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival.”
(http://www.nejm.org/doi/full/10.1056/NEJMoa1000678)
Editorial: Palliative Care — A Shifting Paradigm
The New England Journal of Medicine - August 19, 2010
Amy S. Kelley, M.D., M.S.H.S., and Diane E. Meier, M.D.
“The study by Temel et al. represents an important step in confirming the beneficial outcomes of a simultaneous care model that provides both palliative care and disease-specific therapies beginning at the time of diagnosis. This study is an example of research that shifts a long-held paradigm that has limited access to palliative care to patients who were predictably and clearly dying. The new approach recognizes that life-threatening illness, whether it can be cured or controlled, carries with it significant burdens of suffering for patients and their families and that this suffering can be effectively addressed by modern palliative care teams. Perhaps unsurprisingly, reducing patients' misery may help them live longer. We now have both the means and the knowledge to make palliative care an essential and routine component of evidence-based, high-quality care for the management of serious illness.”
(http://www.nejm.org/doi/full/10.1056/NEJMe1004139)
Medical Society of New York Fights Palliative Care Information Act Despite Mounting Evidence
HuffingtonPost.com – September 3, 2010
Barbara Coombs Lee, Compassionandchoices.org
“The ink of Governor Paterson's signature is barely dry on New York's Palliative Care Information Act (PCIA), drafted and sponsored by Compassion & Choices and its New York affiliate, yet evidence mounts daily for its vast and dramatic impact on end-of-life care. I predict this bill will shift decision-making authority radically from physicians to patients, and dwarf the impact of the Oregon and Washington Death with Dignity bills that, themselves, sent tremors through Medicine over the last thirteen years.”
(http://www.huffingtonpost.com/barbara-coombs-lee/medical-society-of-new-yo_b_705397.html)
The Power of Palliative Care
"Good Morning America" - August 26, 2010.
(http://abcnews.go.com/Health/video/power-palliative-care-well-being-overal-quality-live-response-treament-improved-care-11489699)
Panel Discusses New Studies in Palliative Care
The Diane Rehm Show – Aug. 24, 2010
(http://thedianerehmshow.org/shows/2010-08-24/new-studies-palliative-care)
New Law Could Help Hospice Patients Continue Aggressive Medical Treatments
Kaiser Health News in collaboration with the Philadelphia Inquirer – May 10, 2010
Reported by Medicaid Change
“The new health law could lead to a major change in Medicare policy that allows patients to get treatment and hospice care simultaneously...The new law instructs Medicaid, the state-federal program for the poor, to cover simultaneous hospice and curative care for children with terminal illnesses immediately. And it directs the federal Medicare program, which covers seniors and disabled people, to launch up to 15 pilot projects around the country to test the concept. If the experiment is deemed successful and doesn’t increase costs, then Medicare could make the benefit available to everyone in hospice.”
(www.kaiserhealthnews.org/Stories/2010/May/10/Hospice.aspx)