Sunday, February 17, 2013

Hospice is Being Used More, But So is ICU

USA today article: Hospice & ICU use in Final Month

We're making progress in referring to hospice more often. However, we're also using ICU more during the final month of life. For some patients and families this is what they want, holding out hope for a longer life. But this makes me wonder whether some were in ICU because their wishes weren't determined and documented? Did they have an accurate understanding of their prognosis, and were they and their families prepared? 

I also wonder what that last month was like for these people in ICU and for their loved ones.  Were they comfortable? Did they experience pain, distress or worry from medically futile tests treatments? Were their psychosocial and spiritual needs adequately met? Did they have the information and support they needed to make complex decisions? 

The reality is that many people with HF die in the hospital. Many want CPR and other life-saving interventions, often because they have been saved by these in the past. They want the defibrillator on until the end. And this is fine- it's their choice. Regardless of these types of decisions, how can we promote the best end-of-life experience possible for every patient, no matter what their choices and no matter where they die?

Palliative care is not just a special medical team, or place or organization. Palliative care is a philosophy, a mind set, a choice we make about how we care for people. And it's a philosophy we can use wherever we practice. 

  • We provide palliative when we provide information about what to expect and support with decision-making. 
  • We provide palliative care when we promote comfort, quality of life and dignity for the individual.
  • We provide palliative care when we keep the patient and family as the focus of our care.
While we are making progress in promoting hospice referral for our patients with advanced HF, we should also consider how we promote the best end-of-life experience possible in the hospital as well. Our patients and their families deserve no less. 

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