What if I told you about an organization you could call when your elderly parent became so seriously ill that it appeared unlikely she’d recover?
What if I told you that this organization would send well trained nurses to see your parent, aides to lend a hand with daily care, a social worker to help the family grapple with the emotional difficulties? That these folks would deliver equipment you might need — a hospital bed, say, or wheelchair — and all your parent’s drugs? What if they’d also send a chaplain if you wanted one? And provide a nurse to call 24/7 when you had questions or problems? And volunteers who would stay with your parent while you took a few hours’ break, even if just for a long, quiet
And what if I told you all this would cost you nothing, that Medicare would pay for it all? You’d pick up the phone, right? It’s what caregivers so often yearn for and so seldom can locate: expertise, compassion, help that they can afford.
Now, what if I told you this organization was a hospice?
Yesterday's Doctor and Patient column by Paula Chen, MD discussed the difficulty of end-of-life conversations between a doctor and patient, and also talks about her own recent experience with her mother-in-law's death. She writes about doctor's being unsure if having a conversation about dying is doing more harm than good to the patient.
One particular study came back to me during these last few weeks, a study that attempted to answer just this question. Published last fall in The Journal of the American Medical Association, the study examined how end-of-life care discussions with terminal patients affected their quality of life and that of their caregivers.
Over the course of almost six years, Professor Holly Prigerson, director of the Center for Psycho-oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, and her colleagues interviewed more than 300 terminal patients, asking them if their doctors had ever discussed care at the end of life. After these patients died, the investigators analyzed the type of medical care received prior to death, then interviewed the patients’ caregivers six months later to assess how they were adjusting to their loss.
What Dr. Prigerson and her co-investigators found was that those patients who had had discussions with their physicians were more likely to have better quality of life at the end of their lives. These patients were not more depressed or more worried as a result of these discussions, and they tended to receive less aggressive medical care and earlier hospice referrals. Moreover, their caregivers fared better and suffered from significantly less depression six months after the patient’s death than caregivers whose loved ones had received more aggressive care.
Read the comments to this column here.
