New Hospice Model Allows Curative Therapy To Continue

New Hospice Model Allows Curative Therapy To Continue

Posted on Wednesday, May 14th, 2014 at 3:56 pm by lifemediamatters

This piece was first published in Reuters Health. LMM President Randi Belisomo is a contributor.

A new program from the Centers for Medicare and Medicaid Services may remove a barrier that makes patients hesitate to opt for hospice care near the end of life.

Until now, to receive hospice care, patients had to agree to forego any further attempts at curative treatments. The new Medicare Care Choices Model will soon offer an option for Medicare beneficiaries to receive palliative care services from certain hospices while still receiving treatment from curative care providers.

Eytan Szmuilowicz, MD

Dr. Eytan Szmuilowicz

Dr. Eytan Szmuilowicz, a palliative care physician at Northwestern University’s Feinberg School of Medicine in Chicago, told Reuters Health that the new program may ease the burden families face in choosing treatment options.

“Now, we have a problem with patients having to make a choice,” Szmuilowicz said. “It may be based on hope that a treatment will continue to work, even if chances are low. This way, they are not forced to make this choice.”

“There is so much stigma around hospice, and it’s so negative in people’s minds, many can’t bring themselves to try it,” Szmuilowicz added. “If we open the door to help people realize the benefits hospice can bring, it may allow them more time to realize these therapies aren’t helping that much. Maybe that’s a good thing.”

In testing the Medicare Care Choices Model, CMS plans to evaluate whether providing hospice services earlier can improve quality of life among patients and reduce Medicare spending. CMS will limit participation to beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS.

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Lawmakers Propose Incentives For End Of Life Planning

Posted on Tuesday, May 6th, 2014 at 2:56 pm by lifemediamatters

This piece was first published in Reuters Health. LMM President Randi Belisomo is a contributor.
U.S. Sen. Tom Coburn, R-Okla. WikiMedia Commons.

U.S. Sen. Tom Coburn, R-Okla. WikiMedia Commons.

If you are one of the estimated 70 percent of Americans who have not documented your end-of-life healthcare preferences, Republican Senator Tom Coburn of Oklahoma hopes a cash incentive will prompt you to do the paperwork.

Under his newly introduced Medicare Choices Empowerment and Protection Act, seniors could pocket up to $75 for completing advance directives. Directives are written instructions in which people specify what healthcare actions should be taken if they cannot speak for themselves.

“It’s just smart,” says Coburn, a family physician. “This is good medicine for a doctor to know what a patient wants.”

The bill, co-sponsored by Democratic Senator Chris Coons of Delaware, would encourage people on Medicare to register advance directives with the Centers for Medicare and Medicaid Services (CMS). Medicare beneficiaries would receive a one-time payment of $75 for creating an online directive, or $50 for creating one manually in 2015. The payment from CMS would come either as a check or direct deposit.

Inflation would determine payment in subsequent years.

“Here is an incentive to say ‘I want all the care that I can get,’ or perhaps, ‘here is the care that I want,’ and put it down,” says Coburn, who was diagnosed with a prostate cancer recurrence last year. He recently announced his retirement from the Senate effective next January.

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How Do You Know When It’s Time For Hospice?

Posted on Monday, April 28th, 2014 at 2:26 pm by lifemediamatters

This piece was first published in Reuters Health. LMM President Randi Belisomo is a contributor.

Worn out and needing someone to know she was desperate, Jen Bosworth called her mother’s physician.

The Chicago-area drug counselor had spent two years caring for 67-year-old breast cancer patient Ines at the time in 2011, and her mother’s wellbeing was declining as quickly as the cancer seemed to explode.

“She was having problems getting around, and treatments weren’t working,” recalls Bosworth, then a 35-year-old newlywed. “She was spending more time being schlepped around than enjoying life.”

Bosworth’s doctor welcomed the call, offering a new option: hospice care. “I was totally afraid of that word,” remembers Bosworth, who wrote a one-woman show about her mother’s illness, Why Not Me: Love, Cancer and Jack White. “I thought it meant she would die the next day.”

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Spirituality At End Of Life

Posted on Friday, December 28th, 2012 at 5:07 pm by Life Matters Media

Spirituality

Physicians and nurses at Boston medical centers cited a lack of training as the main reason why they rarely provided spiritual care for their terminally ill cancer patients, even though most patients considered it important to their end of life care.

A new study published in the Journal of Clinical Oncology reports that out of the 204 physicians from four medical centers who participated in the three year study, just 24 percent reported providing spiritual care. Among the 118 nurses, only 31 percent reported providing care.

“I was quite surprised that it was really just lack of training that dominated the reasons why,” senior author Dr. Tracy Balboni, an oncologist at the Dana-Farber Cancer Institute in Boston and researcher of spirituality, told Reuters Health.

Spiritual care may range from prayer with a physician or nurse to recommendations for a hospital chaplain.

Spiritual care “is considered by patients to be an important aspect of end of life care and is also associated with key patient outcomes, including patient quality of life, satisfaction with hospital care, increased hospice use, decreased aggressive medical interventions, and medical costs,” Balboni said.

Even though current palliative care guidelines encourage medical practitioners to mind religious and spiritual needs that arise during a patient’s end of life care, most medical practitioners remain silent. Ninety-four percent of patients with advanced cancer had never received any form of spiritual care from physicians.

Stanford School of Medicine

Stanford School of Medicine

Spiritual care may become more common in the future, however. “There was a time when nurses and physicians may have said, ‘That’s not my job,’ but I think the tides are changing,” said palliative care researcher Betty Ferrell of City of Hope, a cancer research center in Duarte, California.

“I think we are realizing we can no longer ignore this aspect of care,” Ferrell told Reuters. She’s a professor of nursing who was not involved in the new study.

Study researchers suggest more spiritual care training for physicians and nurses. The study found only 13 percent of doctors and nurses reported having such training. However, those who received training were almost 11 times more likely to provide spiritual care to their patients than those who had not.


Terminally Ill Opt For Less Treatment When In Communication With Doctors

Posted on Tuesday, November 27th, 2012 at 1:43 pm by Life Matters Media

Cancer patients who talk with their physicians about how they want to die are less likely to opt for aggressive end of life treatments in the last two weeks of life, according to a new study published in the Journal of Clinical Oncology. Instead, these patients end life more comfortably at home or in hospice care, and as a result spend much less on hospital care.

“Aggressive care at the end of life for individual patients isn’t necessarily bad, it’s just that most patients who recognize they’re dying don’t want to receive that kind of care,” said Dr. Jennifer Mack, lead author of “Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study.”

“We should at least consider having these discussions soon after diagnosis if we know that a patient has incurable cancer,” Mack, from the Dana-Farber Cancer Institute in Boston, told Reuters Health.

The researchers studied more than 1,200 patients with stage IV lung or colorectal cancer who survived at least one month from the time of diagnosis, but died during the 15-month study period. Using interviews of the patients and/or their caregivers and a comprehensive medical record review, the researchers determined if and when the patients had discussions with their doctors about end of life.

Researchers found that 88 percent had end of life discussions, but more than one-third of those took place less than a month before the patient died. Those patients who had end of life discussions documented in the medical record but did not recall them in the patient or surrogate interviews were more likely to have chemotherapy within the last 14 days of life, or acute intensive or hospital care within the last 30 days of life.

Patients who reported having the discussions with doctors were almost seven times more likely to end up in hospice than those who didn’t have those talks. Hospice focuses on comfort care and pain management for terminal patients, instead of treatment.

“A lot of patients don’t want (aggressive treatment), but they don’t recognize that they’re dying or that this is relevant for them,” said Dr. Camilla Zimmermann, head of the palliative care program at University Health Network in Toronto. She wasn’t involved in the study.

She told Reuters: “The earlier you discuss these things, the more options you have. If you wait too long, you end up having these discussions with someone you don’t know, that you just met, in an inpatient setting,” instead of with your primary doctor.

According to Mack, “If we start these conversations early, then patients have some time to process this information, to think about what’s important to them (and) to talk with their families about that.”

In 2010, Medicare paid $55 billion for doctor and hospital bills during the last two months of patients’ lives- more than the budget for the Department of Homeland Security, according to CBS News. Twenty to 30 percent of those medical expenses may have had no meaningful impact on the patients’ health.

Reuters is reporting data from the Dartmouth Atlas of Health Care, which found that 32 percent of total Medicare spending goes to caring for sick patients in their last two years of life.

National guidelines recommend patient-physician talks begin soon after a terminal cancer diagnosis. Researchers found that physicians initiated end of life discussions an average 33 days before death.