The Hospice Philosophy Death isn’t failure of healthcare, but a part of healthcare! Dame Cicely Saunders Founder of St. Christopher’s Hospice, 1967 What is the Difference Between Hospice and Palliative Care? Hospice is an insurance benefit Palliative Care is a treatment philosophy Palliative Care: Can be engaged in life threatening illness much Palliative earlier in acute care when Care curative treatment still on-going. Hospice Hospice-A 1982 Medicare benefit. For last 6-months of life. Usually home or residential based. Used when curative care no longer pursued NHPCO’s Hospice Philosophy Statement Hospice provides support and care for persons in the last phases of an incurable disease so that they may live as fully and as comfortably as possible. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. Hospice affirms life and neither hastens nor postpones death. Hospice exists in the hope and belief that through appropriate care, and the promotion of a caring community sensitive to their needs that individuals and their families may be free to attain a degree of satisfaction in preparation for death. Hospice recognizes that human growth and development can be a lifelong process. Hospice seeks to preserve and promote the inherent potential for growth within individuals and families during the last phase of life. Hospice offers palliative care for all individuals and their families without regard to age, gender, nationality, race, creed, sexual orientation, disability, diagnosis, availability of a primary caregiver, or ability to pay. Hospice… • Focuses on quality of life for patient and family. • Focuses on celebration of life when time is precious. • Hospice patient’s suffer less, pain, depression and other maladies • Hospice patient’s cost less to care for than dying patient’s not in hospice • In general-hospice patient’s live longer in hospice than matched controls not in hospice • Is provided by a team that provides for physical, emotional, social and spiritual care during the last stages of illness, dying and bereavement period. What is our job in medicine? • It’s NOT to ensure health and survival • We have remarkable power to push against the limits of genes, cells, flesh, and bone • This power is, and will always be, finite • It IS to enable well-being – the reasons one wishes to be alive • It’s not death that the very old fear, it’s what happens short of death. Dr. Atul Gawande – “Being Mortal: Medicine and What Matters in the End.” p259, p 285 Hippocrates Said: • "To impose treatment on the patient overmastered by disease is to display an ignorance akin to madness.” Curative Vs. Palliative Primary Goal = cure Primary Goal = relieving suffering Object of Treatment = the disease Object of Treatment = patient and family Symptoms treated primarily as clues to diagnosis Distressing symptoms treated as entities themselves Primary value placed on measurable data such as labs and tests Subjective and measurable data valued This model tends to devalue data that is This model values patient experience as an illness subjective, immeasurable or unverifiable Therapy indicated if it controls symptoms for Therapy indicated if it eradicates disease or slows relieves suffering progression Patient is viewed as complex being with physical Patient’s body differentiated from mind emotional social and spiritual dimensions Patient viewed as collection of parts so there is Treatment congruent with values, beliefs and little need to get to know the whole person concerns of patient & family Death is the ultimate failure Enabling a patient to live fully and comfortably until he or she dies is a success Principal Goals of Hospice are Minimize Suffering and promote Healing Suffering Healing is not curing Pain Healing is about Delirium wholeness Dyspnea Reconciliation; repairing relationships Nausea/vomiting Finding meaning and Constipation purpose in reviewing one’s Anxiety/depression life near the end Spiritual Angst About finding completion “The Talk” - “Dr. Informative” • A common pit-fall of having extensive medical knowledge. • It’s the meaning behind the information that people are looking for more than facts. • The best way to convey meaning is to tell people what the information means to you. • “I am worried.” Dr. Atul Gawande – “Being Mortal: Medicine and What Matters in the End.” p206 “The Talk” - 3 Important Questions 1. What are your biggest fears and concerns? 2. What goals are most important to you? 3. What trade-offs are you willing to make, and what ones are you not? Dr. Atul Gawande – “Being Mortal: Medicine and What Matters in the End.” p234 Discussion Questions • What do you think “medicalized” mortality means? • How can we shift to a more humane, compassionate approach to mortality? • When is the appropriate time to introduce hospice in the treatment of those with life-threatening illnesses .