Pub Date : 1989-01-01DOI: 10.1177/104990918900600103
F Eldridge
{"title":"A special fundraising event: advantages and disadvantages for the hospice organization.","authors":"F Eldridge","doi":"10.1177/104990918900600103","DOIUrl":"https://doi.org/10.1177/104990918900600103","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 1","pages":"6, 11"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13853627","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 : 1989-01-01DOI: 10.1177/104990918900600105
R E Enck
{"title":"The management of malignant dysphagia.","authors":"R E Enck","doi":"10.1177/104990918900600105","DOIUrl":"https://doi.org/10.1177/104990918900600105","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"6 1","pages":"9-10"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918900600105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13853629","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 : 1988-11-01DOI: 10.1177/104990918800500606
F Eldridge
{"title":"A \"Catch 22\" dilemma--establishing and funding small rural hospices.","authors":"F Eldridge","doi":"10.1177/104990918800500606","DOIUrl":"https://doi.org/10.1177/104990918800500606","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"19, 21"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331569","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 : 1988-11-01DOI: 10.1177/104990918800500604
R E Enck
{"title":"Mucosal membranes as alternative routes for morphine sulfate administration.","authors":"R E Enck","doi":"10.1177/104990918800500604","DOIUrl":"https://doi.org/10.1177/104990918800500604","url":null,"abstract":"","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"17-8"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331568","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 : 1988-11-01DOI: 10.1177/104990918800500608
W D Hakkarinen
The percentageof elderly individualsin family physianpractices is growing,which increasestheneed for familyphysiciansto carefor terminally ill patients.AIDS has increasedthe numberof terminallyill youngpeople,and thereis concern that thistrendwill continueoverthe next severaldecades. The Wyoming Valley Family PracticeResidency Programin conjunctionwith Hospice St. Johnhasdevelopeda rotation to betterpreparefamilypractice residentsto carefor terminallyillpatients.HospiceSt. Johnin Kingston, Pennsylvaniais a nonprofithospice operatedby LutheranWelfareServices in Hazleton,Pennsylvania. The program director of the Wyoming Valley Family PracticeResidency servesastheHospiceMedicalDirector, and residentshavebecomeinvolvedin all areasof hospicecare. Educational objectivesfor theresidentsareto become:1) cognizant of theissuesof sufferingin terminallyill patients, 2) adeptin themedicalcare ofterminallyill patients,3) comfortable discussingmedicalissueswith terminally ill patients and their families, 4) awareof the ethical issuesrelatedto the careofterminally ill patients,and5) familiar with the hospiceinterdisciplinaryteam and the waysotherprofessionalshelprelieve suffering in terminally ill patients. Structureof therotation Residentshave experiencesin threemajorareas:theinterdisciplinary team meeting, the patient’s home, and the hospiceinpatient unit. Teammeetingswith residentparticipation are heldweekly. At these meetings,thereis discussionof all newly admittedpatients,patient deaths, andanongoingreviewofactive patients.Nurses,socialworkers, homehealthaides,clergy, administrators,andfacultyphysicianscontribute information each from their perspectiveregardingeach patient andfamily. Specificinterventionsare planned,andprevious interventions areevaluated. Eachresidentisexpectedto make home visits in the companyof the hospicenurse.During thesevisits, theresident seesthepossibilitiesand limitations of home care. The presenceof aphysician,evenif basically as an observer,has been reportedby hospicenursesto be of immeasurablecomfort to patient and family. In the inpatient unit residents function as primary physiciansfor thosepatientswithout an attending physician. Under supervisionof familypracticefaculty, residentsare responsiblefor medicalmanagement and symptom control in patientsadmittedfor respitecareor acutesymptomcontrol. Our experienceconfirms a report in the literature1of a tendencyfor primarycare physiciansto relinquish their patientsto aninstitutional physician ratherthancontinuingas aleaderof the hospiceteam. Residentresponse Residentphysicianshavenoteda variety of experiencesand feelings not typical in a traditional training program.Severalresidentsreported feeling like a family memberor friend after repeatedhome visits. Residentsneedto resistthe idea of cure,andmanyfound it difficult not to respondto signs and symptoms with traditional medical interventions. One residentreportednightmares,andothersrelatedfearsabout their ownhealth. Hospicestaffpersp
{"title":"Hospice care and a family practice residency.","authors":"W D Hakkarinen","doi":"10.1177/104990918800500608","DOIUrl":"https://doi.org/10.1177/104990918800500608","url":null,"abstract":"The percentageof elderly individualsin family physianpractices is growing,which increasestheneed for familyphysiciansto carefor terminally ill patients.AIDS has increasedthe numberof terminallyill youngpeople,and thereis concern that thistrendwill continueoverthe next severaldecades. The Wyoming Valley Family PracticeResidency Programin conjunctionwith Hospice St. Johnhasdevelopeda rotation to betterpreparefamilypractice residentsto carefor terminallyillpatients.HospiceSt. Johnin Kingston, Pennsylvaniais a nonprofithospice operatedby LutheranWelfareServices in Hazleton,Pennsylvania. The program director of the Wyoming Valley Family PracticeResidency servesastheHospiceMedicalDirector, and residentshavebecomeinvolvedin all areasof hospicecare. Educational objectivesfor theresidentsareto become:1) cognizant of theissuesof sufferingin terminallyill patients, 2) adeptin themedicalcare ofterminallyill patients,3) comfortable discussingmedicalissueswith terminally ill patients and their families, 4) awareof the ethical issuesrelatedto the careofterminally ill patients,and5) familiar with the hospiceinterdisciplinaryteam and the waysotherprofessionalshelprelieve suffering in terminally ill patients. Structureof therotation Residentshave experiencesin threemajorareas:theinterdisciplinary team meeting, the patient’s home, and the hospiceinpatient unit. Teammeetingswith residentparticipation are heldweekly. At these meetings,thereis discussionof all newly admittedpatients,patient deaths, andanongoingreviewofactive patients.Nurses,socialworkers, homehealthaides,clergy, administrators,andfacultyphysicianscontribute information each from their perspectiveregardingeach patient andfamily. Specificinterventionsare planned,andprevious interventions areevaluated. Eachresidentisexpectedto make home visits in the companyof the hospicenurse.During thesevisits, theresident seesthepossibilitiesand limitations of home care. The presenceof aphysician,evenif basically as an observer,has been reportedby hospicenursesto be of immeasurablecomfort to patient and family. In the inpatient unit residents function as primary physiciansfor thosepatientswithout an attending physician. Under supervisionof familypracticefaculty, residentsare responsiblefor medicalmanagement and symptom control in patientsadmittedfor respitecareor acutesymptomcontrol. Our experienceconfirms a report in the literature1of a tendencyfor primarycare physiciansto relinquish their patientsto aninstitutional physician ratherthancontinuingas aleaderof the hospiceteam. Residentresponse Residentphysicianshavenoteda variety of experiencesand feelings not typical in a traditional training program.Severalresidentsreported feeling like a family memberor friend after repeatedhome visits. Residentsneedto resistthe idea of cure,andmanyfound it difficult not to respondto signs and symptoms with traditional medical interventions. One residentreportednightmares,andothersrelatedfearsabout their ownhealth. Hospicestaffpersp","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331570","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 : 1988-11-01DOI: 10.1177/104990918800500603
G B Brichacek
Descriptive data on volunteer turnover were collected from inactive volunteersat afull hospiceprogram in the Midwest. Twenty-four inactive volunteers (85 percent female, mean age45.25) responded to a checklist of reasons for volunteer turnover developedfrom literature on volunteer turnover. Reasons were coded according to two categories: administratively uncontrollable and controllable. Frequency distributions and percentages were tabulatedfor the data. Volunteers reported 46 reasons that were coded administratively uncontrollable (74.3 percent) and 16 reasons that were potentially controllable (25.7percent). Fifteen volunteers (62.5percent) considered themselves temporarily inactive with plans to return to active service. The use of turnover data in the evaluation of the volunteerprogram is discussed.
{"title":"Hospice volunteer turnover: a measure of quality assurance in the utilization of volunteers.","authors":"G B Brichacek","doi":"10.1177/104990918800500603","DOIUrl":"https://doi.org/10.1177/104990918800500603","url":null,"abstract":"Descriptive data on volunteer turnover were collected from inactive volunteersat afull hospiceprogram in the Midwest. Twenty-four inactive volunteers (85 percent female, mean age45.25) responded to a checklist of reasons for volunteer turnover developedfrom literature on volunteer turnover. Reasons were coded according to two categories: administratively uncontrollable and controllable. Frequency distributions and percentages were tabulatedfor the data. Volunteers reported 46 reasons that were coded administratively uncontrollable (74.3 percent) and 16 reasons that were potentially controllable (25.7percent). Fifteen volunteers (62.5percent) considered themselves temporarily inactive with plans to return to active service. The use of turnover data in the evaluation of the volunteerprogram is discussed.","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"32-5"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331576","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 : 1988-11-01DOI: 10.1177/104990918800500616
C Rognlie
Introduction The deathof a loved one is the deepest of all sorrows.The griefthat resultsfrom sucha loss canbe very intense and multifaceted,and can eventhroweveryaspect oflife out of balance.Emotionally, grief may evokethestrongest feelingsofanger, guilt,fear,andanguishthataperson has ever felt. Mentally, grief may causeconfusion andevenconcern for one’ssanity.Physically,griefcan be experiencedas sleeplessness, emptiness,exhaustion,or nausea. The closer that one was to the deceased, the more havoc the loss creates. Overthe last 15 yearstherehas beenincreasedsocialrecognitionof the issuesof deathand dying. This awarenesscoupledwith an increasing geriatric population has awakenedformal interest in the processof griefandbereavement intervention.Many hospiceshaveexpandedtheir caregiving servicesto include counselingand support for the bereaved.Theseservicesrange from private counselingto work within smallbereavement groups. The goalof a bereavement support groupisto helpitsmembersaccomplishthe tasksofmourningin a safe and supportive environment. Theemphasisin groupsis on education and support rather than on therapy. In a supportiveenvironment,the bereavedis guidedto completethe two majortasksof grief: to acceptthe deathasrealandto cope with the emotional and social problemsthatarecreatedas aresult of theloss. The BoulderCountyHospiceoffersamodelbereavement groupformat that has beenwidely used by other hospicesacrossthe nationto set up bereavementprograms.Its goals are designedto help group membersbegin to cope with the many changesandproblemsfaced duringthegrievingprocess. Educationandinformationabout the normalgriefprocessarethe first
{"title":"Long-term effects of participation in the bereavement support group at the Hospice of Petaluma.","authors":"C Rognlie","doi":"10.1177/104990918800500616","DOIUrl":"https://doi.org/10.1177/104990918800500616","url":null,"abstract":"Introduction The deathof a loved one is the deepest of all sorrows.The griefthat resultsfrom sucha loss canbe very intense and multifaceted,and can eventhroweveryaspect oflife out of balance.Emotionally, grief may evokethestrongest feelingsofanger, guilt,fear,andanguishthataperson has ever felt. Mentally, grief may causeconfusion andevenconcern for one’ssanity.Physically,griefcan be experiencedas sleeplessness, emptiness,exhaustion,or nausea. The closer that one was to the deceased, the more havoc the loss creates. Overthe last 15 yearstherehas beenincreasedsocialrecognitionof the issuesof deathand dying. This awarenesscoupledwith an increasing geriatric population has awakenedformal interest in the processof griefandbereavement intervention.Many hospiceshaveexpandedtheir caregiving servicesto include counselingand support for the bereaved.Theseservicesrange from private counselingto work within smallbereavement groups. The goalof a bereavement support groupisto helpitsmembersaccomplishthe tasksofmourningin a safe and supportive environment. Theemphasisin groupsis on education and support rather than on therapy. In a supportiveenvironment,the bereavedis guidedto completethe two majortasksof grief: to acceptthe deathasrealandto cope with the emotional and social problemsthatarecreatedas aresult of theloss. The BoulderCountyHospiceoffersamodelbereavement groupformat that has beenwidely used by other hospicesacrossthe nationto set up bereavementprograms.Its goals are designedto help group membersbegin to cope with the many changesandproblemsfaced duringthegrievingprocess. Educationandinformationabout the normalgriefprocessarethe first","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"26-30"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331574","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 : 1988-11-01DOI: 10.1177/104990918800500613
C Lloyd, L Coggles
Many patients with advanced cancer experience pain. Successful pain managementcan be achieved through the coordinated efforts ofthe members of the cancer care team. Multiple methods of treatment need to be employed. Occupational therapy is a vital service in pain management. Its focus is both on modifying the perception of pain and on modifying the individual's lifestyle.
{"title":"Contribution of occupational therapy to pain management in cancer patient with metastatic breast disease.","authors":"C Lloyd, L Coggles","doi":"10.1177/104990918800500613","DOIUrl":"https://doi.org/10.1177/104990918800500613","url":null,"abstract":"Many patients with advanced cancer experience pain. Successful pain managementcan be achieved through the coordinated efforts ofthe members of the cancer care team. Multiple methods of treatment need to be employed. Occupational therapy is a vital service in pain management. Its focus is both on modifying the perception of pain and on modifying the individual's lifestyle.","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"36-8"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500613","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331579","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 : 1988-11-01DOI: 10.1177/104990918800500618
R C Tenney, K E Cotton
A widely quoted statement among providers “we lose money on the Medicare hospice benefit (HB)” is often cited as the reason why more hospices are not participants in the Medicare program. We began this study to detennine the validity of this statement. Our study examined 1987 Medicare cost reports of 15 Colorado hospices to determinerecent costs and compare costs to payment rates. We found that data collected by the cost report isfundamentally inadequate to accurately apportion all Medicare costs. There is an adequatemethodfor only direct salaiy costs. No adequate methods are availablefor other direct costs, such as durable medical equipment-(DME),supplies, ordrugs. There is no way to accurately allocate administrative and general expenses amongthe modalitiesofcare. Methods of segregating Medicare-disallowed costs, such asfundraising, are not adequate to allow these to be properly identified. A cooperative effort is proposed that would unite the hospice community in developing cost accountingreports that can be used inaccurate cost finding and rate setting. Suggested team members are the Health Care Financing Administration (HCFA), the Colorado Hospice Organization (CHO), National Hospice Organization (NHO) and other organizations, hospiceproviders, and consultants.
{"title":"Medicare hospice cost reports yield inaccurate data.","authors":"R C Tenney, K E Cotton","doi":"10.1177/104990918800500618","DOIUrl":"https://doi.org/10.1177/104990918800500618","url":null,"abstract":"A widely quoted statement among providers “we lose money on the Medicare hospice benefit (HB)” is often cited as the reason why more hospices are not participants in the Medicare program. We began this study to detennine the validity of this statement. Our study examined 1987 Medicare cost reports of 15 Colorado hospices to determinerecent costs and compare costs to payment rates. We found that data collected by the cost report isfundamentally inadequate to accurately apportion all Medicare costs. There is an adequatemethodfor only direct salaiy costs. No adequate methods are availablefor other direct costs, such as durable medical equipment-(DME),supplies, ordrugs. There is no way to accurately allocate administrative and general expenses amongthe modalitiesofcare. Methods of segregating Medicare-disallowed costs, such asfundraising, are not adequate to allow these to be properly identified. A cooperative effort is proposed that would unite the hospice community in developing cost accountingreports that can be used inaccurate cost finding and rate setting. Suggested team members are the Health Care Financing Administration (HCFA), the Colorado Hospice Organization (CHO), National Hospice Organization (NHO) and other organizations, hospiceproviders, and consultants.","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"9-12"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14191986","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 : 1988-11-01DOI: 10.1177/104990918800500617
C H Brown
No othersinglediseaseor classofdiseasesexceedscanceras a diagnosismostgreatlyfearedbymodem society.Thefearofsufferingwithuncontrolledsymptomssuchas pain is no lessprofoundlyfearedthandeath itself. The imageof the cancerpatientwastingawayin hisbed,racked with pain, unfortunatelyis the picture one immediately constructs whena diagnosisof canceris given. The most frequentquestionsasked at the time of diagnosisare: “How long can I live?” and “Will I have pain?” In theUnitedStates,therewill be 985,000newcancercasesdiagnosed in 1988.’While an estimated50 percentof thesecan becuredbypresent medical treatmentsincluding surgery, radiation therapy, and chemotherapy,there remainsthe soberingfact thatmorethan490,000 of thosepatientswill ultimately die oftheir malignantdisease. In fact, in 1985, 461,563 personsin the U.S. succumbedto cancer.’Thisaccounts for 22 percentof all deathsduring thatyear.To statethesestatisticsyet anotherway, 170personsper 100,000 populationdiedof cancerin 1985.In my owncommunityof800,000(1985 census),this translatesto 1,360 estimatedcancerdeaths. Is dying of cancerverymuchdifferentfrom dyingof otherdiseases? Certainly,the endresultis the same. However, getting to the terminal eventmaybe quite differentfor the patientwith a malignancy.As contrastedwith the circumstancesinvolved in deathby heart disease, cerebrovasculardisease,accidents, andchronicobstructivelungdisease, the other most commoncausesof deathin this country,mostpatients who succumbto cancerdo not die suddenly.Granted,deathdueto any chronicdiseasemaypresenta situation in which the patientundulysuffers.Symptomsof pain,shortnessof breath,weakness,nausea,and anorexiaarenot exclusiveto malignant disease,but aspredictable,expected symptomsduring the terminal period of illness, theseare more often than not experiencedby the cancerpatient. In termsof predictability,cancer differs from otherterminaldiseases in yet anotherway. The differenceis relatedto expectedsurvival.Virtuallyeverycancer is consideredinterms of annualor five-yearsurvival. Data are so voluminousand statisticsso analyzed,thateachmalignantneo-
{"title":"Medical oncology and hospice: compatible or not?","authors":"C H Brown","doi":"10.1177/104990918800500617","DOIUrl":"https://doi.org/10.1177/104990918800500617","url":null,"abstract":"No othersinglediseaseor classofdiseasesexceedscanceras a diagnosismostgreatlyfearedbymodem society.Thefearofsufferingwithuncontrolledsymptomssuchas pain is no lessprofoundlyfearedthandeath itself. The imageof the cancerpatientwastingawayin hisbed,racked with pain, unfortunatelyis the picture one immediately constructs whena diagnosisof canceris given. The most frequentquestionsasked at the time of diagnosisare: “How long can I live?” and “Will I have pain?” In theUnitedStates,therewill be 985,000newcancercasesdiagnosed in 1988.’While an estimated50 percentof thesecan becuredbypresent medical treatmentsincluding surgery, radiation therapy, and chemotherapy,there remainsthe soberingfact thatmorethan490,000 of thosepatientswill ultimately die oftheir malignantdisease. In fact, in 1985, 461,563 personsin the U.S. succumbedto cancer.’Thisaccounts for 22 percentof all deathsduring thatyear.To statethesestatisticsyet anotherway, 170personsper 100,000 populationdiedof cancerin 1985.In my owncommunityof800,000(1985 census),this translatesto 1,360 estimatedcancerdeaths. Is dying of cancerverymuchdifferentfrom dyingof otherdiseases? Certainly,the endresultis the same. However, getting to the terminal eventmaybe quite differentfor the patientwith a malignancy.As contrastedwith the circumstancesinvolved in deathby heart disease, cerebrovasculardisease,accidents, andchronicobstructivelungdisease, the other most commoncausesof deathin this country,mostpatients who succumbto cancerdo not die suddenly.Granted,deathdueto any chronicdiseasemaypresenta situation in which the patientundulysuffers.Symptomsof pain,shortnessof breath,weakness,nausea,and anorexiaarenot exclusiveto malignant disease,but aspredictable,expected symptomsduring the terminal period of illness, theseare more often than not experiencedby the cancerpatient. In termsof predictability,cancer differs from otherterminaldiseases in yet anotherway. The differenceis relatedto expectedsurvival.Virtuallyeverycancer is consideredinterms of annualor five-yearsurvival. Data are so voluminousand statisticsso analyzed,thateachmalignantneo-","PeriodicalId":77805,"journal":{"name":"The American journal of hospice care","volume":"5 6","pages":"15-6"},"PeriodicalIF":0.0,"publicationDate":"1988-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/104990918800500617","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14331567","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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