Lack of EOL knowledge amongst Careproviders

[softrbreeze]

Just received a call from the daughter of an elderly pt (Mrs X) on hospice with diagnosis of kidney cancer. The daughter had taken her mother to a routine appointment with her cardiologist and the pt was seen by the NP instead of the doctor. I had advised the daughter to let the cardiologist know Mrs X was on hospice and ask if there was anything in particular the cardiologist wanted done as she neared the EOL (Pt has a pacemaker/defibrillator). The daughter reported that the NP exclaimed "What, you just want to die?" to her mother when she asked at what point the defibrillator should be shut off. Both pt and cg have stated that they do not want the pt to be shocked. The daughter stated she got the impression the NP "did not think very much of hospice". Thankfully, the daughter did seem to realize the NP was not very knowledgeable about EOL but this could have ended so very differently with a more ignorant cg. What situations have you seen where the family/cgs were poorly influenced by other healthcare professionals? I swear, EOL guidelines should be taught routinely in every nursing school and medical school!

[SoldierNurse22, BSN, RN]

Man, I've seen all kinds of things done with patients at EOL that are simply horrific. It amazes me that medical schools in particular don't cover this stuff. I mean, life is a terminal condition. EVERY patient you ever have WILL eventually die, but the medical model refuses to recognize that.

Instead, many nurses and physicians alike still see patients who are accepting of death as they reach their end to have something psychologically wrong with them. The idea of not "fighting the good fight" until you can no longer breath (literally) is unimaginable to many providers in American society. I feel that this is one of our great downfalls as a nation and a culture. As a result, many people die in pain with lack of attention to their personal comfort at a time when they need it the most.

[TammyG]

I too have seen many providers openly hostile toward hospice, including one pulmonologist in town that refuses to certify any of his patients until they are, literally, actively dying. I had one lovely man with COPD whom he refused to certify for a year; finally, he did within 48-hours of the patient's death. I think of all the support we could have given the family. Particularly with something like COPD -- I mean, there was no aggressive treatment going on. I find this to be a small minority, but still, even one provider with this attitude is too many.