Gaining Comfort Through Hospice Knowledge
Thank you for your article on “Matters of Life and Death” (Clinician Reviews. 2011;21[7]:cover, 6-8, 19-20). While the intention behind these palliative and end-of-life care information acts is to offer patients better communication, there are two variables that will prevent them from being effective.
The first variable is that the law allows the provider to determine when the patient’s condition becomes terminal. Unfortunately, to many providers, terminal means “no longer treatable.” Consider the bed-bound 94-year-old patient with weight loss and declining function who is brought to the emergency department with aspiration pneumonia. This patient is at high risk for dying, but aspiration pneumonia is “treatable” and therefore she may not be considered terminal.
The second variable is that discussing end-of-life care requires knowledge and skills. Some providers lack knowledge about the benefits and burdens of end-of-life treatments and also may lack the skills to impart the information to families who are in denial.
One solution is for providers to educate themselves about which patients qualify for hospice care. They may be surprised to learn that patients with weight loss, functional decline, and in some cases recurrent infections meet the hospice eligibility criteria. After identifying patients, they can request a hospice consult to work with families, helping them to sort out their wishes around end-of-life care.
Betsy Murphy, FNP, CHPN, Middleburg, VA
The Echoes of Pomp & Circumstance
I really enjoyed the passion Randy D. Danielsen brought to his commencement speech (Clinician Reviews. 2011;21[7]:cover, 40, 42, 43). His comments remind us why we originally went into health care. Thank you for reminding us of both the responsibility and the privilege we have been given in our roles as advanced practice professionals. Finally, the reminder to never become complacent is timely, regardless of whether we are novice or seasoned practitioners. Thanks again for this message!
Heidi Butcher, NP, Downey, CA
Correction
Earlier this year, Zostavax was approved for use in patients ages 50 and older for the prevention of shingles. (Previously, it was approved for ages 60 and older). The June CE/CME article on Adult Immunizations (Clinician Reviews. 2011;21[6]:41-48) did not reflect this information.