Managing End-of-Life Care

This week, many media outlets have reported on findings from a recent study by researchers at Dartmouth College addressing the vast differences in end-of-life care for cancer patients in the U.S. The study addressed concerns that many patients may not receive appropriate end-of-life care, and this care depends heavily on where they are hospitalized.

Patients and their families cannot make choices without information.  As a medical team, the information we convey to patients and families can, at times, be difficult, but it is a vital part to providing patients with the tools they need to make decisions about their care. Patients and their families need time to plan for their future and knowing what they are facing allows them to put these plans into place.  If patients are facing a terminal disease, it allows them to plan a peaceful end-of-life experience.

It is often difficult to separate emotions from logic, and as medical professionals, we need to work together as a team to provide information in a sensitive and caring way that will hopefully allow information about terminal disease to be processed and absorbed over time rather than provided late in a patient’s care, when family members could find it difficult to cope.

Physicians, social workers, Chaplains, nursing staff, and palliative care team members all work together to provide up to date information and supportive counseling.  Each patient and their circumstances are different, but time and time again we have learned that taking action from day one is the best way to provide quality end-of-life care and prevent a sense of regret for the family.

What are the options and when should they be discussed?

While medical teams should discuss palliative care and planning all throughout a patient’s illness, the time for final preparations for end-of-life support is when the medical team determines that there are no further curative treatment options available.  This doesn’t mean that the patient only has days to weeks to live. In fact, we often assist patients and families in preparing for home hospice services six months to a year before their actual death. Home hospice services provide emotional and medical support in the home.

For patients whose end-of-life care would be more safely and comfortably provided in an in-patient hospice setting, medical teams help arrange these services.

End-of-life care systems aren’t perfect, and we are working every day to improve the level of care that patients and families receive, but it’s clear that providing information and services early on to patients and their families, is not only the right thing to do, but helps patients maintain a good quality of life despite their illness.