When should hospice discussion begin? When should hospice discussion begin? - pg.2 | allnurses

When should hospice discussion begin? - page 3

note: i originally posted this in the critical care section with some reads and no responses so i posted here. thanks! i am a nursing student (pre-licensure bsn) and have been impressed by the... Read More

  1. Visit  MissIt profile page
    4
    Quote from tewdles
    He should have been palliating her symptoms rather than allowing her to suffer.
    I hope that one of these days it will be a regular thing for palliative care to be started earlier in the disease process for patients newly diagnosed with these types of diseases. Perhaps it would be "too early" for hospice if their symptoms were managed effectively. Unfortunately, there seems to only be the two options right now for too many people-- suffer and implement all available treatments or not suffer and institute comfort care only. If I'm ever diagnosed with a disease that I know will be both chronic and painful, I'm going to the hospital with a palliative care program in place!
  2. Visit  leslie :-D profile page
    1
    tewdles, i don't know exactly what part of my post you're disagreeing with.
    however, i do and will always, palliate my pts, to extent possible.
    i seriously hope i didn't give anyone the impression that i wouldn't.

    and of course, pcps should be having these discussions w/pt and family, long before disease reaches its advanced stage...
    absolutely!!
    i just wanted to point out that even with education, pts and families have their very unique reasons as to why it'd seem that all this education, went in one ear and out the other.
    there are circumstances, and ingrained values, and personal reasons, why eol care/hospice doesn't always happen.
    actually, more often than not, which makes hospice so underutilized and actively avoided.

    i admire your ideals, but maintain, that until western society changes its attitudes, confronting death will be a slow and arduous journey that benefits no one.

    i still don't know what your concerns were, but hopefully i've addressed them?

    leslie
    tewdles likes this.
  3. Visit  leslie :-D profile page
    0
    Quote from MissIt
    Unfortunately, there seems to only be the two options right now for too many people-- suffer and implement all available treatments or not suffer and institute comfort care only. If I'm ever diagnosed with a disease that I know will be both chronic and painful, I'm going to the hospital with a palliative care program in place!
    i agree, that pall care needs to be aggressively marketed and implemented...especially with pcp's, who are the main treaters in a pt's care.
    they should be recognizing the severity of illness and treating it accordingly.
    i'm very grateful for my doctor, and recognize that not enough docs are like mine.

    leslie
  4. Visit  tgrosz profile page
    2
    leslie, i understand what you are saying. it's not as though
    you quit trying, it's that you know that your trying will often
    be futile because patients and families are just not willing to
    accept the inevitable no matter how much prior education/
    consultation was done. it's very frustrating, and if you push
    too hard you come across as being morbidly obsessed.
    leslie :-D and bsnanat2 like this.
  5. Visit  leslie :-D profile page
    2
    Quote from tgrosz
    leslie, i understand what you are saying. it's not as though
    you quit trying, it's that you know that your trying will often
    be futile because patients and families are just not willing to
    accept the inevitable no matter how much prior education/
    consultation was done. it's very frustrating, and if you push
    too hard you come across as being morbidly obsessed.
    thanks, tgrosz.
    and while i feel eternally discouraged, i will never, ever back down from what i know as righteous.
    (i think God gave me and others, a big mouth for a reason.)
    there are a few docs out there, who avoid me like the plague.

    leslie
  6. Visit  VivaLasViejas profile page
    3
    Growing up with a grandmother who had been a nursing student during the First World War, I formed my own attitudes toward death early on, and have never found much reason to alter them in the 40-plus years since.

    I remember her explaining to me why, sometimes, death was preferably to lingering in some painful or humiliating state. She told me once that pneumonia was called the "old man's friend" back in the day before antibiotics, chest physiotherapy and so on became commonplace in its treatment. When a person developed it in the course of a downhill trajectory, she said, death was not only accepted as the natural outcome, but even welcomed as a deliverer because it meant the end of suffering.

    "When your grandfather and I were young," she said, "death was just a part of life that happened to everyone at some time or another. It took the little children who were too delicate to survive childhood illnesses, and if you made it to old age, it came to live in your house, and sometimes you could feel it bite you in the behind."

    This, to my mind, is a much more compassionate and realistic view of death....certainly more so than our modern way of flogging a failing body with our chemicals and our surgeries and our machines. Sometimes, dead is better........not that anyone should be in a hurry to get there, or to hasten another's demise for economic or other reasons; but when time is short and there is great suffering, it's nothing short of cruel to extend "life"---if indeed that's what it is---beyond the limits of the patient's ability and willingness to endure it.

    Just my $0.02 worth...
  7. Visit  LMTRN profile page
    0
    That New Yorker article was terrific!
  8. Visit  LMTRN profile page
    0
    I am a hospice nurse that works in a local hospital, doing admissions and followups on current patients that come in.

    The hospital system I work with has a "Quality of life" team. They have patients all through the hospital, but they sit in on the "grand rounds" in the ICU. The qlife team works closely with the hospice team, often referring patients to us.
    The qlife team says there are "buzz words" for patients, and doctors routinely write for consults for them if the patient is: on a vent, over a certain age, multiple hospitalizations for the same issues. Not all qlife patients make it to hospice, but it's a good stepping stone.
  9. Visit  Steeleworks profile page
    0
    I have just about finished my book on hospice. In researching it, there is one study that is just getting underway that expects that over 1000K patients annually are DBA or Die Before Admission to hospice. One, literally in the ambulance from the hospital to the home.

    Another study when I was just getting started in hospice found that 78% of patients who qualify for hospice do not get admitted.

    The answer, similar but sooner than what Used Nurse said, we should be talking about it in our young adulthood. When people get closer to their mortality they are more reluctant to speak about it.

    Even in nursing school, I was taught a number of misconceptions about hospice. Although this has probably changed, no wonder so few actually want it.

    And the best part, every year in my last job, we would have to fire about 4-6 patients because they no longer qualify for hospice. Some have other terms for this but the bottom line, they got better with our care.

    This is because hospice helps people live the last days of their lives. Some, a very few, perhaps just change their mind about dying.

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