Hospice Care: The Medical Communities’ Best Kept Secret
Courtesy Altus Healthcare & Hospice, Inc., North Atlanta LIVING WELL Magazine
The old adage of “doctor knows best” is growing more and more obsolete as the years go by. That isn’t meant to disparage physicians, they do their best; but in general, as patients, we assume our physicians know exactly what we want. And naturally, physicians believe they know what our goals for treatment are––to be cured.
But what happens when aggressive curative treatments have the effect of actually decreasing a patients’ quality of life? Disease cannot always be cured, and disability cannot always be reversed. At that point, is being cured really still the end goal for the patient, and does trying to find that cure actually lead to a better, more comfortable and happier life? What do patients really want at the end-of-life? Do they want their physicians to do everything possible to extend their life? Do they want more time in the hospital? If additional treatments offer little possibility of benefit, do they want more invasive care? The answer is a resounding “no.”
For patients with long-term health conditions their goal becomes the relief of symptoms, an enhanced quality of life, prevention of complications, and emotional and spiritual support for their family. This misalignment of doctor and patient goals at the end-of-life has sadly resulted in diminished quality of life.
Research suggests that the care patients get is not necessarily the care they want. Evidence from a study funded by the Robert Wood Johnson Foundation showed that most patients with serious illness said they would prefer to die at home. Yet most patients died in hospitals. Care was rarely aligned with their reported preferences.
Among the patients who indicated that they preferred to die at home, the majority, 55%, actually died in a hospital. This study shows that end-of-life discussions and the communication of preferences with both family and physicians are paramount to a better quality of life.
But, talking about death can be difficult, and oftentimes doctors and family members avoid these conversations in fear of causing more worry, depression and decline for the terminally ill. The misconception is that not having these conversations will be more comfortable both psychologically and physically for the patient. However, a study conducted by the Department of Medical Oncology and Center for Psycho-Oncology and Palliative Care Research found that end-of-life discussions were not associated with higher rates of patient depression, worry and decline. In fact, they were associated with lower rates of aggressive and invasive treatments, earlier hospice enrollments, more patient control and a higher quality of life.
Many people believe that hospice care is giving up on getting well and giving in to illness, and sadly, many physicians and healthcare professionals view hospice the same way, as some sort of death sentence. But hospice care exists to meet the needs of the patient at the end of their life, and can actually lengthen the life of the patient. One recent study by the National Hospice and Palliative Care Organization found that people who chose hospice care lived an average of one month longer than similar people who did not opt for hospice.
The patient-centered philosophy of hospice is a multidisciplinary team of physicians, nurses, social workers and clergy that care for the dying and their loved ones, by providing social, spiritual, and emotional support.
The hospice philosophy of care does not seek to hasten death; it just does not seek to unnaturally and painfully prolong life. It treats death, as a natural part of life, not something to perpetually fight against. It is simply a way to reduce and manage the physical and emotional pain, stress and suffering for both the patient and their loved ones during the dying process. It allows the patient and their families to regain control of their life through the dying process. It allows the patient to decide the setting and the treatment in order to maximize the happiness of their final days.
Because talking about death is taboo, people end up dying expensive deaths in hospitals in which quality of life is not the major concern, instead of dying at home, with compassionate hospice care that puts their quality of life at the forefront.
All too often, the medical community is startlingly unprepared for properly dealing with death. End-of-life conversations and an openness to hospice care would make the end-of-life a much less scary occasion and would allow each of us to find peace in life’s final season.
To learn more, contact Altus Healthcare and Hospice, Inc. at 770-730-8405, or visit www.altushospice.com.
