William Osler (1849 - 1919), Professor of Clin...

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“The physician’s goal  is “to cure sometimes, to relieve often, and to comfort always.”

–  Sir William Osler

Just recently, Hall of Fame boxing champion Joe Frazier passed away due to Liver Cancer.  Smokin’ Joe was Muhammad Ali’s nemesis in the “Thrilla in Manila“, one of the greatest heavyweight boxing matches of the 20th century.  In his final days, with curative treatment taking a back seat, news went around that Joe was under hospice care.  It brought a smile on my face, seeing how hospice care is now starting to emerge as a practice.  However, we may still need to strengthen research and information dissemination regarding hospice and palliative care among those outside the medical community.

Below are some of the latest research articles on hospice and palliative care.

  1. A study was done regarding the use of cancer screening procedures among patients with advanced cancer.  Such tests include mammography, Pap smear, PSA, and colonoscopy.  It was concluded that a number of patients with advanced cancer continue to undergo tests that produce little clinical benefit. This shows that those who are not familiar with palliative and hospice care principles are exposed to unnecessary tests that neither prolong life nor improve the patient’s quality of life.(Sima CS, et al.  Cancer screening among patients with advanced cancer.  JAMA. 2010 Oct 13;304(14):1584-91. )
  2. Palliative Care results in a 43% reduction in ICU admissions among patients with advanced disease, and a $464 reduction in direct hospitalization costs. (p < 0.001).   (Penrod JD, et al. Hospital-Based Palliative Care Consultation: Effects on Hospital Cost. Journal of Palliative Medicine. August 2010: 973-979)
  3.  A prospective, multisite study of 343 patients with advanced cancer revealed the following:

a.  Patients whose spiritual needs were largely or completely supported by the medical team received more hospice care

b.  High religious coping patients whose spiritual needs were largely or completely supported were more likely to receive hospice and less likely to receive aggressive care

c.  Spiritual support from the medical team and pastoral care visits were associated with higher Quality of Life scores.

(Source: Balboni, TA et al.  Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol, 2010. 28(3): p. 445-52.)

4.  The reasons why patients do not enroll in a hospice care program include patient and family misperceptions regarding hospice care, lack of knowledge regarding hospice care services, and concerns regarding access to hospice care services.  (Why Don’t Patients Enroll in Hospice? Can We Do Anything About It? Elizabeth K. Vig, Helene Starks, Janelle S. Taylor, Elizabeth K. Hopley and Kelly Fryer-Edwards)

5.   Patients with cancer who died in an intensive care unit (ICU) or hospital experienced more physical and emotional distress and worse Quality of Life at the End of Life (all P ≤ .03), compared with patients who died at home with hospice.

6.  ICU deaths were associated with a heightened risk for posttraumatic stress disorder, compared with home hospice deaths

7.  Hospital deaths were associated with a heightened risk for prolonged grief disorder (21.6% [eight of 37] v 5.2%, compared with home hospice deaths.

8.  Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%).  This shows that advance care planning is crucial in providing direction for care at the end of life.  ( Silveira MJ et al.  Advance directives and outcomes of surrogate decision making before death.  N Engl J Med. 2010 Apr 1;362(13):1211-8.)

So what are the implications of these studies?  This just shows that being cared for by a hospice and palliative care practitioner at the end of life results in better quality of life, decreased medical expenses, and better social and spiritual support for patients and their caregivers.

It’s high time that we give hospice and palliative care the importance that it deserves.



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