Table 4. Common Myths of Hospice (Continued) Myth #6: Hospice is for people who don’t need a high level of care.
False: Hospice and palliative care is serious medicine and can be quite high level. Most hospices are Medicare-certified, requiring that they employ experienced and highly skilled medical and nursing personnel. There are four levels of hospice that reflect the changing needs patient may have while under care. Hospices also offer state-of-the-art palliative care, using advanced technologies to prevent or alleviate distressing symptoms. False: While those affected by terminal illness struggle to come to terms with death, hospices gently help them find their way at their own speed. Many hospices welcome inquiries from families who are unsure about their needs and preferences. Hospice staff are readily available to discuss all options and to facilitate family decisions. False: Most people who use hospice are entitled to the Medicare Hospice Benefit. This benefit covers virtually all hospice services and requires little, if any, out-of- pocket costs. This means that there are no financial burdens incurred by the family, in sharp contrast to the huge financial expenses at the end of life that may be incurred when hospice is not used. Medicaid and most private insurances also have hospice benefits where services are covered. False: While managed care organizations (MCOs) are not required to include hospice coverage, Medicare beneficiaries can use their Medicare hospice benefit anytime, anywhere they choose. They are not locked into the end-of-life services offered or not offered by the MCOs. Those that do have MCO plans may have hospice coverage that is detailed in their plan. False: When death is in sight, there are two options: Submit without hope or live life as fully as ever until the end. The gift of hospice is its capacity to help families see how much can be shared at the end of life through personal and spiritual connections often left behind
Myth #7: Hospice is only for people who can accept death.
Myth #8: Hospice care is expensive.
Myth #9: Hospice is not covered by managed care plans.
Myth #10: Hospice is for when there is no hope.
(American Hospice Foundation, n.d.-a, p. 1). Other barriers to the delivery of hospice and palliative care include both the education and training of healthcare providers in this specialty area. The National Consensus Project for Quality Palliative Care (NCP) aims to formalize and delineate evidence- based processes and practices for the provision of safe and reliable high-quality palliative care in all care settings (National Coalition for Hospice and Palliative Care, 2018). The overview and scope of the fourth edition of the NCP Clinical Practice Guidelines for Quality Palliative Care (2018) is to: ● Improve access to palliative care for those with serious illness in all care settings by integrating palliative care principles and best practices into routine assessments and care ● Formalize evidence-based practices for palliative care for seriously ill adults and children in all care settings ● Provide guidelines to assist in developing palliative care reimbursement mechanisms that are linked to standardized care, as payers (e.g., Medicare Advantage plans) are exploring ways to pay for better access to palliative care Case Study 2 Robert is an 87-year-old male patient who was diagnosed several weeks ago with pancreatic cancer that was found to be advanced. Robert has been undergoing radiation therapy to shrink the cancer, control his symptoms, and prolong his life. His medical oncology team has also referred Robert for chemotherapy after his radiation therapy is complete. Robert is informed that his pancreatic cancer is “locally advanced,” meaning that the cancer has not yet spread to distant locations in the body but has extended into local areas around the pancreas. Robert understands that his type of pancreatic cancer is very difficult or impossible to surgically remove completely. In addition, Robert has been losing weight and appears slightly jaundiced. He explains to his primary care nurse that he feels “so weak” all the time. Robert reports that he was experiencing some pain, but the radiation therapy has been helping with relieving his pain somewhat. Robert’s oncologist, Dr. Rupert, calls a family meeting to discuss Robert’s status and goals of care, and to introduce the integration of palliative care into his treatment plan. Robert’s
wife, Mary, and his two middle-aged daughters show great concern for Robert’s condition and prognosis during the meeting. Dr. Rupert explains that although he cannot predict Robert’s life expectancy, he does not expect Robert’s condition to permanently improve or his symptoms to completely disappear. When Robert states that he does not want treatment to extend life given his condition, his family agrees with this decision. They also do not want to continue Robert’s suffering, given his prognosis. Dr. Rupert clarifies the decision to write a do-not-resuscitate order with Robert, who gives his consent to write the order. Dr. Rupert then introduces Diane, the palliative care nurse in the hospital. Diane explains that she will assess Robert and his family to determine their level of distress and functioning so that an appropriate plan of care to support everyone’s needs can be developed. The integration of palliative care into Robert’s current treatment plan is being offered to Robert to improve his quality of life. Quality of life is improved by providing prevention and relief of suffering and early identification and treatment of pain. Diane describes how palliative care goes on even after Robert and his family may decide to stop treating his pancreatic cancer. Diane then schedules a time with Robert and his family to conduct a palliative care assessment of their physical, psychological, social, and spiritual needs. Questions 1. What will Diane review and discuss with Robert and his family during the hospital-based palliative care assessment? Which decisions will be addressed? 2. What might Robert’s palliative care routine and services include? 3. How will Robert’s quality of life improve by receiving palliative care? Responses 1. During the palliative care assessment, Diane will assess Robert’s and his family members’ quality of life. To do so, Diane will assess their physical, psychological, social, and spiritual aspects of suffering. Assessment and treatment of pain, as well as support for any other issues identified
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Book Code: PYFL4024
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