Pub Date : 2002-07-01DOI: 10.1177/104990910201900403
S. Baumrucker
hospice and palliative care learned their craft on the job; opportunities for full-time employment were rare, and formal postgraduate education was nonexistent. Common wisdom held that the average medical student received approximately six hours of education in end-of-life issues (implying that half the students received even less). Hospice nurses are, in some areas, the most independent practitioners in the whole field of nursing; they are often faced with a “do whatever and I’ll sign it” attitude by doctors whose fund of knowledge in basic symptom control is sorely lacking. Nurses have learned to practice without the input of knowledgeable physicians for the most part, but this freedom tends to be as frightening as it is liberating. Endof-life care, as all care, should be practiced within a team model. When one member of the team is missing, the game will often be lost (to stretch the metaphor). Primary care physicians are not really to blame for this situation, any more than high school students who graduate without learning to read should be blamed if no one notices or remedies the problem. Of course, the world is no longer quite so bleak. Medical schools, for the most part, are adding mandatory contact hours in end-of-life care, and elective rotations in hospice or palliative care are increasing. The number of full-time jobs for hospice medical directors is also increasing as hospice finally reaches the far corners of our country, and hospitals and cancer centers are sprouting palliative care services like spring flowers. This begs the question, however: who will fill these new positions? In my talks across the country, I have always asserted that symptom control and end-of-life care should be an integral part of every primary-care practice. I often half-heartedly joke that our goal should be to make physicians such as myself obsolete—as long as we wait until I retire to do it. As our specialty progresses and becomes more evidence-based, and as it becomes more technically advanced, with tricky opioid rotation schedules and highly evolved procedures, I realize that my dream of a specialty-free world of primary care physicians practicing state-of-the art palliative care is untenable. However, the current milieu is unacceptable as well, and so a compromise must be found. Consider cardiology; this is an essential subspecialty of internal medicine that practices a remarkably advanced form of medicine, with rapidly advancing research and technology. Most primary care physicians refer to cardiologists readily, but they don’t do so in a vacuum. Before graduation, internists and family practitioners have had intensive training in the diagnosis and treatment of circulatory disorders and are quite comfortable treating congestive heart failure, hypertension, and other common maladies. If the relationship between primary care and cardiology was analogous to that of primary care and
{"title":"The ABMS, the ABHPM, and the future of a specialty","authors":"S. Baumrucker","doi":"10.1177/104990910201900403","DOIUrl":"https://doi.org/10.1177/104990910201900403","url":null,"abstract":"hospice and palliative care learned their craft on the job; opportunities for full-time employment were rare, and formal postgraduate education was nonexistent. Common wisdom held that the average medical student received approximately six hours of education in end-of-life issues (implying that half the students received even less). Hospice nurses are, in some areas, the most independent practitioners in the whole field of nursing; they are often faced with a “do whatever and I’ll sign it” attitude by doctors whose fund of knowledge in basic symptom control is sorely lacking. Nurses have learned to practice without the input of knowledgeable physicians for the most part, but this freedom tends to be as frightening as it is liberating. Endof-life care, as all care, should be practiced within a team model. When one member of the team is missing, the game will often be lost (to stretch the metaphor). Primary care physicians are not really to blame for this situation, any more than high school students who graduate without learning to read should be blamed if no one notices or remedies the problem. Of course, the world is no longer quite so bleak. Medical schools, for the most part, are adding mandatory contact hours in end-of-life care, and elective rotations in hospice or palliative care are increasing. The number of full-time jobs for hospice medical directors is also increasing as hospice finally reaches the far corners of our country, and hospitals and cancer centers are sprouting palliative care services like spring flowers. This begs the question, however: who will fill these new positions? In my talks across the country, I have always asserted that symptom control and end-of-life care should be an integral part of every primary-care practice. I often half-heartedly joke that our goal should be to make physicians such as myself obsolete—as long as we wait until I retire to do it. As our specialty progresses and becomes more evidence-based, and as it becomes more technically advanced, with tricky opioid rotation schedules and highly evolved procedures, I realize that my dream of a specialty-free world of primary care physicians practicing state-of-the art palliative care is untenable. However, the current milieu is unacceptable as well, and so a compromise must be found. Consider cardiology; this is an essential subspecialty of internal medicine that practices a remarkably advanced form of medicine, with rapidly advancing research and technology. Most primary care physicians refer to cardiologists readily, but they don’t do so in a vacuum. Before graduation, internists and family practitioners have had intensive training in the diagnosis and treatment of circulatory disorders and are quite comfortable treating congestive heart failure, hypertension, and other common maladies. If the relationship between primary care and cardiology was analogous to that of primary care and","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"7 1","pages":"225 - 227"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90287152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900412
G. Zeppetella, M. Ribeiro
Episodic pain is a common problem for patients with advanced cancer and is often difficult to manage successfully. In this article, the daily variations in cancer-related episodic pain in a patient with metastatic lung cancer are described. The definition, etiology, prevalence, and pharmacological management of episodic pain are also reviewed.
{"title":"Episodic pain in patients with advanced cancer","authors":"G. Zeppetella, M. Ribeiro","doi":"10.1177/104990910201900412","DOIUrl":"https://doi.org/10.1177/104990910201900412","url":null,"abstract":"Episodic pain is a common problem for patients with advanced cancer and is often difficult to manage successfully. In this article, the daily variations in cancer-related episodic pain in a patient with metastatic lung cancer are described. The definition, etiology, prevalence, and pharmacological management of episodic pain are also reviewed.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":" 26","pages":"267 - 276"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91410223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900410
James S.A. Green
The use of palliative services by prostate cancer patients was assessed in relation to other cancer patients and as a proportion of men diagnosed with prostate cancer. Retrospective analysis of palliative care referral and inpatient and outpatient activity was undertaken in respect to patients with nine types of cancer. A cohort of men diagnosed with prostate cancer in 1993 was followed for five years. The records of those that died during this period were reviewed to confirm if they had received hospice care. Of the 118 men dying of prostate cancer, 25.4 percent used hospice services, 23 percent used the hospice at home services (for an average of 68.8 days), while 7 percent used day-care services (for an average of 8.25 days). Prostate cancer patients formed the third largest cancer referral group to hospital-based palliative care services (9.5 percent). They had the third longest survival time from referral (3.8 months) and the oldest average age of death of any group. Lower than average inpatient stays, coupled with the highest average length of stay, led to the third highest use of inpatient services by patients with prostate cancer. We concluded that the morbidity from prostate cancer leads to a high use of palliative services. This significant use of resources should be included in comparisons assessing and planning health care strategies for prostate cancer.
{"title":"An investigation into the use of palliative care services by patients with prostate cancer","authors":"James S.A. Green","doi":"10.1177/104990910201900410","DOIUrl":"https://doi.org/10.1177/104990910201900410","url":null,"abstract":"The use of palliative services by prostate cancer patients was assessed in relation to other cancer patients and as a proportion of men diagnosed with prostate cancer. Retrospective analysis of palliative care referral and inpatient and outpatient activity was undertaken in respect to patients with nine types of cancer. A cohort of men diagnosed with prostate cancer in 1993 was followed for five years. The records of those that died during this period were reviewed to confirm if they had received hospice care. Of the 118 men dying of prostate cancer, 25.4 percent used hospice services, 23 percent used the hospice at home services (for an average of 68.8 days), while 7 percent used day-care services (for an average of 8.25 days). Prostate cancer patients formed the third largest cancer referral group to hospital-based palliative care services (9.5 percent). They had the third longest survival time from referral (3.8 months) and the oldest average age of death of any group. Lower than average inpatient stays, coupled with the highest average length of stay, led to the third highest use of inpatient services by patients with prostate cancer. We concluded that the morbidity from prostate cancer leads to a high use of palliative services. This significant use of resources should be included in comparisons assessing and planning health care strategies for prostate cancer.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"86 1","pages":"259 - 262"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76814736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900407
M. J. Giblin
Living ethically in the face of death is a major challenge for the ill person, the family, and the hospice staff. Beyond the recognized need for ethical decision-making regarding medical principles, there are decisions about character for all involved: “What kind of person will I be?” “What kind of family will we be?” “What kind of caregiver will I be?” “What kind of community will we be?” This article is a discussion of virtues that are appropriate in hospice staff and volunteers: compassion/empathy, faithfulness, justice/advocacy, and practical wisdom. The author calls for a wider sharing of their knowledge and experience.
{"title":"Beyond principles: Virtue ethics in hospice and palliative care","authors":"M. J. Giblin","doi":"10.1177/104990910201900407","DOIUrl":"https://doi.org/10.1177/104990910201900407","url":null,"abstract":"Living ethically in the face of death is a major challenge for the ill person, the family, and the hospice staff. Beyond the recognized need for ethical decision-making regarding medical principles, there are decisions about character for all involved: “What kind of person will I be?” “What kind of family will we be?” “What kind of caregiver will I be?” “What kind of community will we be?” This article is a discussion of virtues that are appropriate in hospice staff and volunteers: compassion/empathy, faithfulness, justice/advocacy, and practical wisdom. The author calls for a wider sharing of their knowledge and experience.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"39 1","pages":"235 - 239"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80075120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900414
J. Ufema
{"title":"Mary, the prisoner who stole our hearts","authors":"J. Ufema","doi":"10.1177/104990910201900414","DOIUrl":"https://doi.org/10.1177/104990910201900414","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"6 1","pages":"283 - 284"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85990323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900409
K. Baldwin, L. Miller, Joseph Scott
Seizures are a common neurologic consequence of various etiologies in the end-stage cancer patient. Because dying cancer patients and their families are often coping with new challenges daily, any intervention that can prevent further patient or family discomfort should be implemented. The purpose of this study was to evaluate four pharmacy interventions aimed at improving nursing care to cancer patients at a facility for the terminally ill. The four interventions were development of a seizure risk factor assessment toll, assembly or availability of a diazepam seizure kit, nursing education via in-service training, and development of a manual for nursing stations. Successful implementation of this project indicated that nurses perceived an empowerment in improving quality of life of their patients.
{"title":"Proactive identification of seizure risk improves terminal care","authors":"K. Baldwin, L. Miller, Joseph Scott","doi":"10.1177/104990910201900409","DOIUrl":"https://doi.org/10.1177/104990910201900409","url":null,"abstract":"Seizures are a common neurologic consequence of various etiologies in the end-stage cancer patient. Because dying cancer patients and their families are often coping with new challenges daily, any intervention that can prevent further patient or family discomfort should be implemented. The purpose of this study was to evaluate four pharmacy interventions aimed at improving nursing care to cancer patients at a facility for the terminally ill. The four interventions were development of a seizure risk factor assessment toll, assembly or availability of a diazepam seizure kit, nursing education via in-service training, and development of a manual for nursing stations. Successful implementation of this project indicated that nurses perceived an empowerment in improving quality of life of their patients.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"192 1","pages":"251 - 258"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85006985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900413
J. Puetz, J. Bouhasin
Few options are available to treat hemorrhaging during the palliative care of patients. Blood products, such as plasma and platelets, are difficult to transfuse in the home or hospice setting. What is needed is a product that can be given in the home setting for effective control of hemorrhaging in patients with various types of coagulopathies. Unfortunately, no such product currently exists. One agent that may be beneficial in this clinical setting is recombinant factor VIIa. This factor was approved initially for controlling hemorrhaging in patients with hemophilia who have developed antibodies against factor VIII, known as inhibitors. It subsequently has been found to control bleeding in several other clinical situations. We will describe our use of this agent during the palliative care of a patient with numerous insults to his coagulation system.
{"title":"Use of recombinant factor VIIa to control bleeding in an adolescent male with severe hemophilia A, HIV, thrombocytopenia, hepatitis C, and end-stage liver disease","authors":"J. Puetz, J. Bouhasin","doi":"10.1177/104990910201900413","DOIUrl":"https://doi.org/10.1177/104990910201900413","url":null,"abstract":"Few options are available to treat hemorrhaging during the palliative care of patients. Blood products, such as plasma and platelets, are difficult to transfuse in the home or hospice setting. What is needed is a product that can be given in the home setting for effective control of hemorrhaging in patients with various types of coagulopathies. Unfortunately, no such product currently exists. One agent that may be beneficial in this clinical setting is recombinant factor VIIa. This factor was approved initially for controlling hemorrhaging in patients with hemophilia who have developed antibodies against factor VIII, known as inhibitors. It subsequently has been found to control bleeding in several other clinical situations. We will describe our use of this agent during the palliative care of a patient with numerous insults to his coagulation system.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"5 1","pages":"277 - 282"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85317637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1177/104990910201900408
J. Cowan, D. Walsh, J. Homsi
Purpose: (a) To report the medical complexity of cancer and noncancer patients receiving palliative medicine (PM) consultation at a tertiary medical center and (b) to describe the consult recommendations made for this group. Patients and methods: Prospective data collection was performed on all consultations (cancer, n = 175; non-cancer, n = 35) done by first author (JDC) as a PM fellow at the Cleveland Clinic Foundation between July 1998 and April 1999. A computer database was used to query for demographics, complexity of medical problems, current medications, mortality, symptoms, nursing problems, and consult recommendations. Results: A median of three (range, 0-12) acute medical problems and three (range, 0-16) chronic medical problems were identified for each patient. Patients were taking a median of six medications (range, 0-20). They had a median of five symptoms (range, 0-13) with pain (73 percent) being most common, followed by weakness (40 percent) and shortness of breath (40 percent). Cancer patients were twice as likely to have more than five symptoms (48 percent versus 23 percent) (chi-square = 0.006). The most common nursing problems were ambulation or fall risk (15 percent) and skin integrity (11 percent). A median of five (range, 1-11) management recommendations were made as part of each consultation. These included medication changes in 81 percent, nonmedication changes in 53 percent, and follow-up services in 100 percent. The median survival from the time of consultation for the known dead was 29 days with 65 percent living more than 14 days. Conclusion: Multiple recommendations were made with most patients surviving long enough potentially to benefit. Consultation in palliative medicine is a sophisticated intervention involving considerable acuity and complexity of care.
{"title":"Palliative medicine in a United States cancer center: A prospective study","authors":"J. Cowan, D. Walsh, J. Homsi","doi":"10.1177/104990910201900408","DOIUrl":"https://doi.org/10.1177/104990910201900408","url":null,"abstract":"Purpose: (a) To report the medical complexity of cancer and noncancer patients receiving palliative medicine (PM) consultation at a tertiary medical center and (b) to describe the consult recommendations made for this group. Patients and methods: Prospective data collection was performed on all consultations (cancer, n = 175; non-cancer, n = 35) done by first author (JDC) as a PM fellow at the Cleveland Clinic Foundation between July 1998 and April 1999. A computer database was used to query for demographics, complexity of medical problems, current medications, mortality, symptoms, nursing problems, and consult recommendations. Results: A median of three (range, 0-12) acute medical problems and three (range, 0-16) chronic medical problems were identified for each patient. Patients were taking a median of six medications (range, 0-20). They had a median of five symptoms (range, 0-13) with pain (73 percent) being most common, followed by weakness (40 percent) and shortness of breath (40 percent). Cancer patients were twice as likely to have more than five symptoms (48 percent versus 23 percent) (chi-square = 0.006). The most common nursing problems were ambulation or fall risk (15 percent) and skin integrity (11 percent). A median of five (range, 1-11) management recommendations were made as part of each consultation. These included medication changes in 81 percent, nonmedication changes in 53 percent, and follow-up services in 100 percent. The median survival from the time of consultation for the known dead was 29 days with 65 percent living more than 14 days. Conclusion: Multiple recommendations were made with most patients surviving long enough potentially to benefit. Consultation in palliative medicine is a sophisticated intervention involving considerable acuity and complexity of care.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"91 1","pages":"240 - 250"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83494232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1177/104990910201900302
J. Varga
effective palliative prescribing, I find the Hospice of the Bluegrass (HOB) initiative progressive as well as prudent. National hospice economics demand that cost savings and cost reduction issues be addressed using new approaches. The HOB study shows how a clinical pharmacist with a specific expertise in palliative medicine can dramatically affect hospice drug costs without sacrificing quality of patient care. Pharmacy practice, particularly in nonhospital settings, has traditionally focused on fundamental services such as accurate dispensing, recording keeping and profiling, and timely delivery of medications. On occasion, true therapeutic intervention occurs. These services alone add little value to pharmaceutical care and save little money; if they did, drug costs would not continue to escalate rapidly for the majority of hospices. Administrators and supervisors may be lead to believe that nothing can be done about the cost of drug therapy and accept it as a consequence of doing business. What the HOB study clearly shows is that something can be done; in fact, it clearly substantiates the role and value of a clinical palliative care pharmacist solely dedicated to hospice issues regarding formulary development, prescribing habits, ongoing education, and per-member/per-day patient drug costs. Pharmaceutical care and pharmacy itself constitute core services that all hospices must provide. Yet how many hospices have an independent palliative care pharmacist consulting and advocating for their hospice and its patients? A hospice administrator would never consider foregoing legal or accounting counsel in his or her organization. With drug costs frequently representing over 20 percent of direct expenses for patient care, it is practical and responsible to have a clinical palliative care pharmacist available to the hospice team. When considering contracting such a clinician for your hospice, the following check list may be useful in determining a potential candidate’s qualifications and experience:
{"title":"A prescription for drug cost savings","authors":"J. Varga","doi":"10.1177/104990910201900302","DOIUrl":"https://doi.org/10.1177/104990910201900302","url":null,"abstract":"effective palliative prescribing, I find the Hospice of the Bluegrass (HOB) initiative progressive as well as prudent. National hospice economics demand that cost savings and cost reduction issues be addressed using new approaches. The HOB study shows how a clinical pharmacist with a specific expertise in palliative medicine can dramatically affect hospice drug costs without sacrificing quality of patient care. Pharmacy practice, particularly in nonhospital settings, has traditionally focused on fundamental services such as accurate dispensing, recording keeping and profiling, and timely delivery of medications. On occasion, true therapeutic intervention occurs. These services alone add little value to pharmaceutical care and save little money; if they did, drug costs would not continue to escalate rapidly for the majority of hospices. Administrators and supervisors may be lead to believe that nothing can be done about the cost of drug therapy and accept it as a consequence of doing business. What the HOB study clearly shows is that something can be done; in fact, it clearly substantiates the role and value of a clinical palliative care pharmacist solely dedicated to hospice issues regarding formulary development, prescribing habits, ongoing education, and per-member/per-day patient drug costs. Pharmaceutical care and pharmacy itself constitute core services that all hospices must provide. Yet how many hospices have an independent palliative care pharmacist consulting and advocating for their hospice and its patients? A hospice administrator would never consider foregoing legal or accounting counsel in his or her organization. With drug costs frequently representing over 20 percent of direct expenses for patient care, it is practical and responsible to have a clinical palliative care pharmacist available to the hospice team. When considering contracting such a clinician for your hospice, the following check list may be useful in determining a potential candidate’s qualifications and experience:","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"57 1","pages":"153 - 153"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72639054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-05-01DOI: 10.1177/104990910201900307
P. Fine
Palliative radiation therapy is a potentially valuable, but rarely used, tool in end-of-life care programs (e.g., hospice) that could greatly enhance the quality of life in appropriately selected patients with advanced cancer who still have more than a few weeks or months to live.1 Although there are no data on hospice utilization of radiation therapy, it is commonly known within the field that, of the more than one-half million patients who are cared for in hospice programs annually, very few are ever considered for this form of therapy. This is primarily due to the perception that this form of therapy is overly burdensome to the patient and financially untenable under the provisions of the Medicare hospice benefit (the main payer for hospice care), which pays about $100 per day for all services related to the terminal diagnosis. Since conventionally applied radiation therapy fractionation regimens may average 12 or more treatment sessions, requiring frequent trips and considerable time spent at a treatment center, and at costs that are prohibitive under this Medicare prospective payment plan, hospice programs are loathe to advocate for this form of therapy. Conversely, because Medicare payment streams are mutually exclusive, patients with relatively limited prognoses who opt for radiation therapy forcibly deny themselves and their families the more fully featured supportive end-of-life care provided by hospice. On the surface, this would appear to be an irreconcilable “systems” problem, only to be resolved by restructuring Medicare financing. However, a review of the radiation therapy literature from the last several years suggests that markedly abbreviated radiation therapy treatment schedules can be highly therapeutic, cost-effective, and relatively without burden, making palliative radiotherapy a worthy treatment option for patients in hospice programs.2 In fact, this review reveals that there are few radiation therapy outcome studies that can empirically direct the care we give to patients with far-advanced cancer. Much of the practice of radiation oncology seems to be based upon the cumulative observations and experiences of individual therapists, built upon those passed down by their mentors and reinforced through individual practice patterns. As a result, widely variable approaches are taken to manage similar cases, without well-defined differences in clinical results. The intent of this article is to summarize the evidence found in the contemporary radiation therapy literature, with the hope that hospice programs will rethink their hesitant stance on this potentially beneficial therapy, and that radiation therapists will adapt their practices to better serve the needs of patients with limited life expectancy.
{"title":"Palliative radiation therapy in end-of-life care: Evidence-based utilization","authors":"P. Fine","doi":"10.1177/104990910201900307","DOIUrl":"https://doi.org/10.1177/104990910201900307","url":null,"abstract":"Palliative radiation therapy is a potentially valuable, but rarely used, tool in end-of-life care programs (e.g., hospice) that could greatly enhance the quality of life in appropriately selected patients with advanced cancer who still have more than a few weeks or months to live.1 Although there are no data on hospice utilization of radiation therapy, it is commonly known within the field that, of the more than one-half million patients who are cared for in hospice programs annually, very few are ever considered for this form of therapy. This is primarily due to the perception that this form of therapy is overly burdensome to the patient and financially untenable under the provisions of the Medicare hospice benefit (the main payer for hospice care), which pays about $100 per day for all services related to the terminal diagnosis. Since conventionally applied radiation therapy fractionation regimens may average 12 or more treatment sessions, requiring frequent trips and considerable time spent at a treatment center, and at costs that are prohibitive under this Medicare prospective payment plan, hospice programs are loathe to advocate for this form of therapy. Conversely, because Medicare payment streams are mutually exclusive, patients with relatively limited prognoses who opt for radiation therapy forcibly deny themselves and their families the more fully featured supportive end-of-life care provided by hospice. On the surface, this would appear to be an irreconcilable “systems” problem, only to be resolved by restructuring Medicare financing. However, a review of the radiation therapy literature from the last several years suggests that markedly abbreviated radiation therapy treatment schedules can be highly therapeutic, cost-effective, and relatively without burden, making palliative radiotherapy a worthy treatment option for patients in hospice programs.2 In fact, this review reveals that there are few radiation therapy outcome studies that can empirically direct the care we give to patients with far-advanced cancer. Much of the practice of radiation oncology seems to be based upon the cumulative observations and experiences of individual therapists, built upon those passed down by their mentors and reinforced through individual practice patterns. As a result, widely variable approaches are taken to manage similar cases, without well-defined differences in clinical results. The intent of this article is to summarize the evidence found in the contemporary radiation therapy literature, with the hope that hospice programs will rethink their hesitant stance on this potentially beneficial therapy, and that radiation therapists will adapt their practices to better serve the needs of patients with limited life expectancy.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"2 1","pages":"166 - 170"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80901986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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