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It seems not a week goes by without hearing something on the news about
improving end-of-life care for your
patients. Whether it is social media, TED talks, medical blogs, celebrity
doctors, or old-fashioned newspapers, the
public conversation about death and dying has certainly risen decibels in the
past decade. One frequent thread of this
discussion has been how physicians discuss death and dying with their patients.
Delivering sad news to patients that
includes discussing end-of-life options can be very difficult for the patient,
their family members, and providers ?
particularly in a busy office practice. With this thought in mind, we want to
thank you for your care of AmeriHealth
members and, whether you are newly trained or a seasoned physician, we hope the
information below can help with
discussions of mortality.
Care options
Identifying what is important to the patient and what he or she values
during the end stages of their life is essential to
making your patient feel acknowledged, comfortable, and respected during an
extremely challenging and emotional
time.
End-of-life treatments are designed to keep the patient as comfortable as
possible. Both palliative care and hospice
care provide comfort measures.
- Palliative care: Care can begin at the time of diagnosis and can be
provided during the same time as treatment.
- Hospice care: Care is implemented after treatment of the disease has
ended and it is evident that the patient?s
likelihood of survival is less than six months.
Hospice care focuses on caring for patients whose primary goal is comfort as
they near the end of life rather than
curative interventions. Hospice care is typically provided at home, at a
hospice center, in a hospital, or in a skilled
nursing facility. Hospice is a covered benefit for commercial managed care
members. Medicare Advantage members
may receive hospice care from any Medicare-certified hospice. Payment is made
by Original Medicare. Members
should consult their Evidence of Coverage for details.
Tips for an effective discussion
If you have not had the experience yet of having an end-of-life
discussion with your patients (or would appreciate
a refresher), here are some key tips in helping prepare for the conversation:
- Do not rush the conversation.
- Hold the discussion in a private, quiet place where everyone can be seated
comfortably to participate in the
conversation.
- Discuss the patients? diagnosis, including what the patient understands and
the expected prognosis.
- Identify the patients? goals for end-of-life care and discuss their
advanced directives. If they do not have an
advanced directive, encourage them to make one.
- Discuss the differences between palliative care and hospice care and engage
the patient and their family in a
thoughtful conversation about which course of action is best for the
patient.
- Become familiar with your local hospital Palliative Care team and how to
refer to them.
With hospice care, an individualized care plan is developed to keep the
patient as comfortable as possible, taking into
consideration the physical, emotional, and spiritual pain that often
accompanies terminal illness, as well as offering
support to the caregiver(s) during the illness and grief support after the
death of their loved one.
End-of-life care can be met with many challenges, but having thoughtful and
meaningful conversations with patients
and family members can help them make decisions that are beneficial for the
patient to live the remaining part of their
life in comfort and with dignity.
Visit our
website to access additional provider and member
resources to assist you with end-of-life discussions and decision-making.]