END-OF-LIFE CARE: PHYSICIAN CALLS FOR FUNDAMENTAL REFORMS
One of the nation's leading geriatric physicians called forThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
a "bold new approach" yesterday to end-of-life care and proposed
a new program "that focuses on the needs and wishes" of such
patients rather than on "the routine use of high tech
interventions that might prolong life but often compromise the
quality of life." In a editorial in this week's edition of the
NEW ENGLAND JOURNAL OF MEDICINE (NEJM), Dr. Joanne Lynn, director
of the Center to Improve Care of the Dying at The George
Washington University Medical Center, said that the current
medical system focuses "excessively" on "rescue, cure and
survival," at the expense supportive services and symptom control
for patients suffering from long term fatal illnesses (The George
Washington University Medical Center release, 7/17).
TAKE CARE: According to Lynn, "Outside of hospice
programs, most patients face substantial pain and isolation and
much preventable adversity as they die." In order to change
this, she said that a delivery system should be designed around
the priorities of the patient, including: pain relief,
"maintenance of function and control, support of family and
personal relationships, avoidance of impoverishment,
trustworthiness and continuity, attentiveness to meaningful
activities, and spiritual issues" (Lynn, NEJM, 7/18 issue). She
said that such a program, which would be called "MediCaring,"
would "emphasize its link to the commitment that society once
made to the elderly with the establishment" of Medicare. Lynn
noted that some of the characteristics of MediCaring could be
implemented immediately, "such as more focus on pain by doctors,
more demand by patients and families for quality care that
emphasized caring over rescue, cure and survival."
THE RIGHT DIRECTION: Lynn writes that under MediCaring,
priorities would be shifted "away from medical treatment and
toward caring." Lynn said that currently too much money is spent
on "inappropriate hospital and medical services," and that
MediCaring would divert these resources into supportive care.
As a result, Lynn said, the "needs of the patient and the
capacity of our health care delivery system would be better
matched" (George Washington release, 7/17). She added, "Everyone
should be confident of receiving compassionate and appropriate
care as he or she enters the valley of the shadow of death"
MORE: A study appearing in today's NEJM found that hospice
care is less expensive and more comfortable for terminally ill
patients, but that many dying patients enter hospice care too
late to realize any benefits. "Ideally" patients enroll in
hospice about three months before their death, AP/Tucson ARIZONA
DAILY STAR reports. However, the study of 1990 Medicare claims
data found that on average patients entered a hospice 36 days
before they died; 15.6% died within one week. Dr. Leslie
Blackhall, medical director of a California-based hospice, said,
"Part of hospice care is psychological support and spiritual
support, and you can't do much of that if you get them a few days
before they die" (7/18).