Wednesday, October 30, 2013
- Increased # of patients served* (1.5M)
- Increasing average length of service (71.8d)
- Decreased median length of service (18.7d)
- Slightly higher percentage of elderly patients served
- Higher diversity of patients served
- Increasing percentage of non-cancer diagnosis led by debility and dementia
- Increasing number of hospice programs (5,500)
- Increasing percentage of for-profit hospice programs
- Increase in Inpatient Hospice (GIP) days
- Declining satisfaction rates (although still high)
- 2013 http://www.nhpco.org/sites/default/files/public/Statistics_Research/2013_Facts_Figures.pdf
- 2012 http://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf
- 2011 http://www.nhpco.org/sites/default/files/public/Statistics_Research/2011_Facts_Figures.pdf
- 2010 http://www.stjosephhospice.com/wp-content/uploads/2011/01/Hospice_Facts_Figures_Oct-2010.pdf
- 2009 http://ebookbrowsee.net/nhpco-facts-and-figures-pdf-d146287250
- 2008 http://www.lovinghandshospice.com/pdf/nhpco_facts-and-figures.pdf
- 2007 http://web.archive.org/web/20081001182409/http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-figures_Nov2007.pdf
- 2006 Summary http://www.allhealth.org/briefingmaterials/NHPCO-NHPCOsFactsandFigures-2005Findings-760.pdf
- 2006 State Supplement http://www.hpcai.org/documents/filelibrary/documents/pdf/NHPCO_NDS_2006_State_Report_FINAL.pdf
Wednesday, October 30, 2013 by Christian Sinclair ·
Thursday, October 24, 2013
I had just begun reading Dr. Danielle Ofri's latest book, "What Doctors Feel: How Emotions Affect the Practice of Medicine", when I opened The New England Journal of Medicine to find David Korones' essay "What would you do if it were your kid?" As he points out, nearly all of us have been asked, have heard this "plea to share with them, as a partner, the heavy burden of decision making." And nearly all of us have squirmed in our seats a little each time.
I still remember the child in the ICU, sedated and on a ventilator as her parents waited for the fungus in her lungs to clear. The note on her door said, “Docs, if ‘Plan A’ didn’t work, the alphabet has 25 more letters! So stay cool.” Yet, the infection was persistent, and her parents were asked to decide – continue as is, perform surgery to remove the fungal ball, or to withdraw the ventilator support and keep her comfortable as she died. The whole team gathered with the parents – the ICU doc, the BMT primary, the infectious disease specialist, the cardiothoracic surgeon, and me, the palliative care doc. The options were presented. The table fell silent as the parents processed the decision before them. Then the father asked, “What would you do?” And after a few furtive glances, one-by-one every provider around that table shared their opinion.
There was not a unanimous response from the providers at the table. But everyone sat with the parents as they faced a heart-wrenching decision. Two years after her death, her parents sat before a group of second year residents and reflected on that family meeting, and on the empathy they felt. It buoys them on their waves of grief to this day.
While the word "empathy" does not appear in Korones’ essay, I think it is at the heart of everything he says. Perhaps it is because I was reading Ofri’s book, and on page 48 she explains,
“Empathy is a cognition, a thought process that allows you to understand the patient’s feelings while not necessarily feeling them yourself… and the empathic doctor needs to be able to clearly communicate that understanding” (p48).When a patient or a family member asks, “What would you do?”, they are inviting empathy.
1. Korones DN (2013). What would you do if it were your kid? The New England Journal of Medicine, 369 (14), 1291-3 PMID: 24088090
2. Meyer EC, Lamiani G, Foer MR, Truog RD (2012). "What would you do if this were your child?": practitioners' responses during enacted conversations in the United States. Pediatric Critical Care Medicine 13 (6) PMID: 23034458
Thursday, October 24, 2013 by Jenni Linebarger ·
Friday, October 11, 2013
- European Association for Palliative Care (EAPC)
- International Association for Palliative Care (IAHPC)
- Worldwide Palliative Care Alliance (WPCA) and
- Human Rights Watch (HRW)
As a palliative care doctor, I have seen suffering damage people and families, but I have also seen the ability for skilled clinicians taught the basics of palliative care, who are able to relieve that suffering. In that act of relief, those clinicians also create a healing process for patients and families even in the face of serious illness. With access to critical pain and symptom medications and the proper education more clinicians can make a true difference in people's lives around the world.
Friday, October 11, 2013 by Christian Sinclair ·
Friday, October 4, 2013
In the face of a crisis, many people are challenged to find constructive and meaningful ways to engage in conversation and so often they fall back on platitudes. Simple, hopeful, semi-philosophical phrases we have heard in many other situations may sound important to the speaker, but the receiver finds them meaningless and tone deaf. I'm sure you have heard many of these uttered to patients by well-meaning family friends, and even health care professionals:
"This too shall pass."
"I'm sure it will be OK."
"It is what it is."
"God won't give you more than you can handle."
"Limp, anemic sentiments will not stand in the face of a world that is not as it should be."Pyle explains that this phrase is often sourced to the Bible but the original statement is about temptation not suffering. I think this is a great post to bring to team and discuss how we as professionals who see the intersection of suffering and spirituality everyday deal with statements like this. I posted the article earlier this week to the Pallimed Facebook page, and it garnered a lot of responses. Here is one that I think many in palliative care will agree with:
Call it what you will, but someone people hang on to this for their hope and sanity. Even though I agree with this blog, even his blatant use of calling it what it is, sometimes to "correct" those (in the moment) who are holding on to this falsity as their hope and sanity, it is equivalent to pulling the chair out from under them.When you hear, "God doesn't give you more than you can handle," how do you respond?
H/T to Rick Bauer (@nvrflycoach) for posting the original blog to Twitter
Photo Credit: Not attributable after using Tin Eye Reverse Image Search
Friday, October 4, 2013 by Christian Sinclair ·