patient’s life and can be instrumental for those who have a life-threatening disease and for their family members. 37 Although chaplains, community-based clergy, and pastoral counselors recognize and explore spiritual distress, all professional care providers can inquire into this significant part of the patient’s being. Bowman notes that spirituality is now routinely included in palliative care and that spiritual care is not synonymous with religious practice. 38 This difference
may cause tension for those providing end-of-life care because, all too frequently, patients near the end of life may reveal things when ready to clinicians with whom they experience comfort; clinicians need to be ready to address any spiritual and grief concerns when voiced. 38 Accordingly, a palliative care team may help patients and families move toward acceptance and peace if they are challenged by the illness and are looking for spiritual support. 39,40
COMMON MYTHS AND BARRIERS
Although hospice and palliative care allow patients autonomy to deal with their own illness, there are still misconceptions that contribute to fear and resistance. These misconceptions cause barriers to care delivery. Many people consider hospice synonymous with death, giving up hope, euthanasia, or assisted suicide. Zimmermann and colleagues found when palliative care was introduced to patients, they reported feeling shock and fear, resistance to it, and a lack of relevance to them. 41 Common myths of hospice and palliative care Myth #1: Hospice is a place. False : Hospice is a philosophy and hospice care takes place wherever the patient calls home. Myth #2: Hospice is only for people with cancer. False : More than one-half of hospice patients have diagnoses other than cancer. Hospices serve patients with end-stages of chronic diseases such as COPD, Alzheimer’s, cardiovascular, and neuromuscular diseases. Myth #3: Hospice is only for old people or the last week of life. False : Although most hospice patients are older, hospices serve patients of all ages and may continue to serve patients who outlive their initial prognosis Myth #4: Hospice means patients can no longer choose their care. False : As a family-centered concept of care, hospice focuses as much on individualizing care for the patient and the grieving family as on the dying patient. Patients may decide to return to curative care and be discharged from hospice. Myth #5: Hospice can help only when family members are available to provide care or when hospice is staffed by volunteers. False : Recognizing that terminally ill people may live alone or with family members unable to provide care, many hospices coordinate community resources to identify a location for the patient to receive care. Hospices are staffed by professionals with volunteers as integral members of the team. Myth #6: Hospice means the patient will die faster . False : Hospice and palliative care is serious medicine and can be quite high-level care. Most hospices are Medicare-certified, requiring that they
employ experienced and highly skilled medical and nursing personnel. Hospice is about making the most of the remaining time. Myth #7: Hospice requires a doctor referral. False : Anyone can refer to hospice for a consultation, even the patient or family. If the patient is deemed appropriate, an order from a physician is required before care can be performed. Myth #8: Hospice care is expensive. 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 for hospice benefits where services are covered. Myth #9: Patients are required to have a Do Not Resuscitate (DNR) order for hospice care. False : Having a DNR in place is not a hospice requirement. Myth #10: Hospice is for when there is no hope. False : Hospice is a shift in care to focus on comfort. It does not mean there is nothing that can be done; hospice is something that can be done to help the patient maximize their time left. 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. 42 The overview and scope of the 4th edition of the NCP Clinical Practice Guidelines for Quality Palliative Care 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; and ● 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. 42
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Book Code: MI24CMEB
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