Oncology Nurse Battles Questionable Treatments
Provided by Stan Massey, 9:58 amShouldn’t medical professionals have a better sense of when aggressive treatment is appropriate and when it’s likely to add more suffering without improvements?
At least some medical professionals think so. CNN.com posted yesterday an interesting article by Theresa Brown, an oncology nurse in Pennsylvania, who called out her colleagues in “A Dying Patient is Not a Battlefield.”
Nurse Brown tells the story of a patient in his late 70’s diagnosed with a severe form of leukemia. As his health deteriorated, she notes, “At that point, he could have opted for palliative care and gone home on hospice with a decent enough quality of life to enjoy what little time he had left.”
Instead, he agreed to aggressive treatment after being urged by his oncologist and his family. He confronted the nurse with the anguish his treatment was causing and expressed his desire to stop. But when she told the attending physician – whom Nurse Brown described as “conscientious and caring” – he “prodded the patient” by saying, “You want to keep going, right? Right?” The patient relented.
Talk about putting words in the patient’s mouth! This story is a good example of how physicians could benefit from education and training on having honest, open-ended conversations with patients to determine their true feelings and wishes.
Among other observations, Nurse Brown wants the readers to know about “my patient’s suffering” because he “was never given his real choice between aggressive treatment that might do more harm than good and getting just enough treatment to keep him stable and allow him to go home to be with the people he loved.”
In my opinion, the medical field needs more people like Nurse Brown on the front lines. A dying patient is not a battlefield – but the decision to do what the patient really wants is always a battle worth fighting.
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August 25, 2010
Interest high for hospice marketing to physicians
Provided by Stan Massey, 4:04 pmDuring this year, Transcend has been shining a spotlight on effective marketing to physicians for improving referrals. And across the nation, the response has been strong.
At NHPCO’s 25th Management and Leadership Conference last April, our president Martha Vetter spoke on the topic along with Dr. David Fisher from Chicago. Their breakout session was very well attended, especially considering it was one of several presentations attendees could choose during that time slot.
Our free monthly e-newsletter, Transcendent, declared 2010 as the “Year of the Physician” and has dedicated a variety of feature articles to different aspects of direct-to-physician marketing. Subscribers and readership have climbed throughout the year.
Just last week, we also offered a pay-to-participate hour-long webinar on marketing to physicians. More than 40 hospices from around the U.S. joined us for the presentation.
The implication is clear. Hospices continue to face a significant challenge in convincing physicians to refer patients, especially as early as appropriate. Physicians continue to resist making hospice referrals for a multitude of reasons.
We need to keep working together to show physicians that referring to hospice is a sound evidence-based decision. Want to learn more about strategies and tactics to connect with physicians? Subscribe to our e-newsletter if you haven’t already. And watch for news on another webinar, coming soon.
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August 18, 2010
Positive Sign of the Times
Provided by Janet Bosserman APR Sr. Public Relations Counselor, 9:59 amRecently, a fellow Transcend team member sent me the annual Beloit College Mindset List. The Wisconsin college has been putting the list together for years to remind faculty about “cultural touchstones that shape the lives of incoming freshman students.”
One refreshing inclusion is #34 on the list: “Assisted Living” has always been replacing nursing homes, while Hospice has always been an alternative to hospitals.”
It is truly a positive sign to think that this generation, whether you call them Gen Y, Millennials or Net Generation, knows that hospice is an alternative to hospitals. The fact that they’ve “always” known it shows the seismic shift in knowledge and attitudes which can occur in a few decades.
Let’s hope Beloit College is right about that.
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August 12, 2010
Result of Painful Discussion is Quiet Joy
Provided by Janet Bosserman APR Sr. Public Relations Counselor, 2:13 pmCould it be that one reason many physicians avoid talking about end-of-life issues is because it’s painful? After all, isn’t pain what doctors are trained to alleviate? Being “willing to suffer along with another human being in pain” is in Dr. Brad Stuart’s opinion the essence of talking with patients about impending death.
In a blog post on www.kevinmd.com Dr. Stuart suggests that love and compassion are the traits physicians need when discussing end- of- life issues. He further suggests that “a quiet joy can emerge when people suffer together like this. Medical training seems to have little to say about death, and even less to say about this kind of love.”
A primary care internist who commented on the blog site agreed that compassion is necessary. “So often I’m reminded that being direct and honest with patients is so rare, and often goes a long way in establishing credibility. And that approach certainly does NOT preclude compassion,” the internist wrote.
Are you providing tools to physicians so they can feel more prepared and comfortable having end-of-life discussions? If so, include Dr. Stuart’s piece in the packet. Peer opinions are very persuasive.
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August 2, 2010
Chocolate Ice Cream and Football on TV
Provided by Stan Massey, 11:27 amOur hospice clients, and many other hospices, have a very practical approach to encourage patients and families to consider hospice care. Instead of talking about dying, they talk about goals of living – what do the patients really want to do with their remaining time?
Generally, I hear about common themes that emerge. The patients want to be comfortable and pain-free. They want to be at home. They want to be surrounded by their friends and families.
But never had I heard of such a practical expression than what I read in the outstanding article, “Letting Go”, written by Dr. Atul Gawande in the August 2 edition of The New Yorker. (This may well be the very best article I’ve ever read about the challenges that patients, families and doctors confront when considering a move from curative treatment to hospice care – written by a practicing physician. Don’t be surprised if this blog refers to it often.)
Among many intriguing stories in this article, one comes from Dr. Susan Block, a national expert in managing end-of-life issues. When her father, John Block, was about to undergo surgery for a mass growing on his spinal cord – with an uncertain outcome – Dr. Block said to him, “I need to understand how much you’re willing to go through to have a shot at being alive and what level of being alive is tolerable to you.”
Much to Dr. Block’s surprise, her father said, “Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.”
Her dad ended up living another 10 years after the surgery. But at the end of his life, Dr. Block used that same criteria to weigh whether to approve treatments. If a procedure would still allow her dad to eat chocolate ice cream and watch football on TV, she consented.
If only more physicians and families would have this type of conversation with their patients and loved ones! A great tool for sparking this meaningful discussion comes from our friends at Lower Cape Fear Hospice & LifeCare Center in North Carolina. Check out their excellent website, www.BeginTheConversation.org. And keep encouraging your family, friends, and anyone who will listen to have a discussion about their end-of-life goals and wishes.
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