Category Archives: Guidance to doctors

Another Way Hope Hospice Helps The Community

On most Wednesday mornings, there’s a gathering in the Hope Hospice break room/kitchen area in Hope’s offices.

Carl Lathan, one of Hope Hospice’s Community Liaisons, meets around the kitchen table with a small group of students from the Saint Louis University School of Medicine. Carl provides them with basic information about hospice care.

“Hospice 101,” as he calls it, introduces these med students to a concept unfamiliar to many of them. Each week’s group includes individuals who are high achievers. They have completed their undergrad work and have competed to attain a spot in a leading medical school. They are among our nation’s best and brightest.

Yet, they know little about hospice. Even those students who do have a passing awareness of hospice care are generally unfamiliar with all the various aspects of hospice care. Carl makes sure they understand the main goals of hospice: ensuring patient comfort and controlling patient symptoms. He also mentions the work hospices do in addressing patient and family emotional and spiritual needs.

Carl Lathan has shared this “Hospice 101” with numerous groups of medical students, so he knows what is most important. However, should any area of his imparted insight remain unclear, he always makes sure there is time for questions.

Allowing the medical school students to learn at Hope Hospice headquarters, where they have the opportunity to sit in on the weekly staff meeting, means they have the chance to hear also from other hospice team members.

For some of these students, this visit with Carl may be the only exposure they will receive to hospice care until they become doctors. Giving these SLU School of Medicine students an opportunity to learn from a veteran hospice professional is something that we at Hope Hospice are proud to provide as a community service.

For information about hospice care in metro St. Louis, please call Hope Hospice at 314-984-9800.

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When Should Doctors Talk About Hospice?

Why are many doctors hesitant to recommend hospice care? In some cases, they may be uncertain about the kind of response they will receive from the patient and the family. Doctors have told of family members reacting badly when the mere mention of hospice is presented.

In a recent article, University of Pennsylvania Health System doctor David Casarett spoke about that hesitancy, saying, “Physicians don’t want to cause that sort of distress. We’re basically nice people. We don’t want to walk in and start a conversation that will make a person start crying.”

But that hesitancy to address the possibility of hospice care can prevent patients and families from experiencing the full benefits of the care that hospice provides.

In the same article, Dr. Susan Block of the Dana-Farber Cancer Institute in Boston says, “The average time of the first conversation about end-of-life is 33 days before death. That’s really late, when you think about how much people have to come to terms with.”

She continues, “Hospice is the gold standard for end-of-life care for most people. Yet for many patients, that first conversation about hospice is the first time anyone has told them that their disease wasn’t going well.”

Dr. R. Sean Morrison of Mt. Sinai Hospital in New York offers words that doctors can share with patients when talking about hospice. He suggests doctors say something like this: “I wish we had a treatment that could take [your tumor] away, but we don’t. So we need to focus on other treatments that will enable you to have the best quality of life you can have for the longest period of time. That means focusing on pain, avoiding infections, spending more time with your family.”

We acknowledge the fact that talking about end-of-life issues can be just as difficult for doctors as it is for any of us. We encourage doctors, especially those whose patients are dealing with life-threatening conditions, to mention hospice early in the treatment process, so that patients and family members will have a better understanding of what hospice is and what hospice does.

For more information about hospice care, call us at Hope Hospice at 314-984-9800.

Call Hospice Sooner Rather Than Later

Studies and surveys have shown over and over again that the earlier a patient goes on hospice, the greater the benefits to the patient and caregivers. But many patients still come to hospice too late to receive the full spectrum of hospice services.

Why do patients and caregivers wait too long? In a 2005 survey of families of recently deceased hospice patients, those who felt that their family member had been admitted to hospice too late said the most common barrier was a doctor. Reasons included inaccurate prognoses, disagreements by doctors with hospice philosophies and desires by doctors to pursue further treatment.

Survivors who felt their family member went on hospice care too late were, overall, less satisfied with hospice. Conversely, those who felt their family member became a hospice patient at “about the right time,” are more satisfied.

Of course, in other cases, it is the patient or the family member who may have refused to accept the doctor’s assessment that a condition is terminal.

At Hope Hospice, we admit patients at all stages of end-of-life. Occasionally, a patient dies within just a few days of becoming a Hope patient. We certainly do our best to provide quality service to each patient no matter the circumstance.

But experience has taught us that patients who are on hospice for several weeks or several months develop good relationships with our nurses, home health aides and other professionals. There is trust and good will. We are better able to serve the patient (and the family) when a patient has more time as a Hope Hospice patient.

One of our goals at Hope Hospice is to convince physicians that hospice care is the right thing for their terminal patients whose life expectancy is six months or less. To those in the St. Louis medical community, we encourage you to learn more about hospice and the good things that hospices are doing for patients and families.

If you are a patient or a family member facing a decision about hospice, don’t wait until it’s too late. If you have questions, call us at 314-984-9800.

Getting Doctors to Talk About Hospice

Doctors and other medical personnel need to know about hospice. Doctors who treat patients for conditions that can lead to death should, for the sake of their patients, become familiar with the concept of hospice. Physicians must consider the needs of each patient and be prepared to share information about hospice care in a timely manner.

A report published by University of Nebraska in 2003 states “at least one-quarter of physicians do not discuss hospice options with their terminally ill patients.” This statistic is surprising and baffling. As hospice care becomes more popular among Americans and hospice information becomes more readily available, we must hope that more doctors will talk to terminally ill patients and their families about hospice.

The report also says the timing of the hospice discussion seems to be the single most influential factor in utilization.” It continues: “families who were provided hospice information before and during their relative’s terminal illness were seven times more likely to consider hospice than those families who knew of hospice before the illness but did not receive further information during the illness.”

The message is clear. Doctors should not be afraid to talk about hospice. Hospices need to step up our outreach to the medical community. Patients and families should not pre-empt conversations about hospice.

In fact, patients and family members need to be pro-active so that all avenues of care are explored. Feel free to ask your doctor about hospice at any point during treatment. You may also want to ask friends, your minister and other medical personnel for information and thoughts about hospice.

Another conclusion from the University of Nebraska report is this one: “The majority of hospice family survivors reported that they would have welcomed more information about hospice from their physicians at the time the diagnosis was labeled terminal.”

At Hope Hospice (based in metro St. Louis), we are always ready to answer your questions about hospice care. We are eager to share information about Hope Hospice with patients, family members and doctors. Call us for information at 314-984-9800. Please visit our website: HopeHospiceSTL.com.

Doctors, Get To Know Hospice

Hospice organizations in St. Louis and the US are working to educate the public about hospice care—what it is and what it is not.

At the same time, hospice organizations are working to educate doctors on the benefits hospice care provides at the end of life. In St. Louis, we are blessed with some of the brightest and most caring doctors in the country. Still, there are doctors who are reluctant to share the bad news with a patient that death is close at hand.

Admittedly, this would be a difficult task for any of us to perform. It may be especially tough for doctors whose mission is to extend life. It may hard to admit that a particular patient faces a certain end.

But the comfort of the patient must be the top priority. If given the choice between dying in a hospital while hooked up to tubes and monitors OR dying in your own home, with attentive hospice professionals offering their various services, which would you choose?

Former college basketball coach Charlie Spoonhour recently died. About his passing, the St. Louis Post-Dispatch reported: “It was peaceful,” said his wife, Vicki, who was at his side with other members of his family. “It was better than being in the hospital.”

Dr. Susan Block of Boston, who works with doctors on dealing with end of life issues, was quoted in a 2010 article about hospice in The New Yorker magazine. Her message to physicians, who may have difficulties sharing a terminal diagnosis: “A family meeting is a procedure, and it requires no less skill than performing an operation.” She suggests that doctors ask their patients: “If time becomes short, what is most important to you?”

The New Yorker article also states: “Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others.”

Hospice care makes it more likely that patients can achieve many of those desires as death approaches.

We ask that doctors, and all health care professionals, make efforts to become more familiar with hospice care and all the good things it offers. Directing patients to hospice care can result in numerous benefits to the patient and the patient’s family.