palliative care is the active total care of patients whose disease is not responding to therapeutic treatment. According to Huggins and Brooks (2007), discussing and planning for the end-of-life can be a challenge for both health care provider and patient. Hospice care are one of the few specialties who have focused their efforts on end-of-life, unfortunately for other specialties there are inadequacies and obstacles in facilitating end-of-life care.
Some of the barriers challenging the communication between physician and patient into the discussion of end of life issues are that physicians find it uncomfortable to discuss death and dying and want to avoid their own emotions and the emotions it may bring up in the patient and their families. Also because of the limited training and communication skills dealing with this issue, physicians fail to probe patient’s values and belief systems. Thus when presenting this complex subject it creates misunderstanding and confuses patients with their unclear medical jargon in attempts to describe scenarios and outcomes.
Generally patients want to discuss these issues with their doctors but wait for them to initiate the discussion. Some patients tend to procrastinate the issue especially if they are in good health, and others do not see the importance in advance directives because they expect their families to make decisions for them (Huggins and Brooks, 2007).
There is growing enthusiasm in the United States about the use of electronic medical records (EMRs) in outpatient settings. More than $20 billion of the federal economic stimulus (the American Recovery and Reinvestment Act of 2009) is slated to assist physicians, hospitals, and other health care settings in adopting health information technology (Gill, 2009). The government wants to shift into the ...
The American Association of critical care Nurses sent out a survey to 1409 of its members on their perception of end-of-life care (Berkstrand, Callister, and Kerchhoff, 2006).
61 critical care nurses responded, 485 offered 530 suggestions for improving end-of-life care. In general the nurses desired they had more to say in the care of dying patients. They reported no consistency existed in the way patients were cared for. According to Besckstrand, Callister, and Kirchhoff (2006), patients are spared impending death only to experience a prolonged death due to advancements in diagnosis and treatments of today. The majority of critical care nurses believe that death is a fact of life in the ICU and it should be treated with the dignity and respect it deserves.
They also desired for physicians to learn to know when enough is enough to continuous aggressive treatment when there is little hope of the patient surviving. Respondents identified several obstacles in providing a good death in ICUs. Included were staffing problems and lack of time spent with the patient and their families. Communication challenges such as physicians not being realistic about the patient’s condition and prognosis. Some respondents felt that physicians see death as a personal failure and not as a part of life, thus many patients suffer needlessly.
Cassel and Foley (1996) mention that many medical societies agree that modern medicine has neglected its traditional role to end-of-life issues. In September 1996, Cassel and Foley called together representatives of medical specialty societies to propose an advance in clinical policy for care at the end-of-life. The Joint Commission on Accreditation of Health Organizations also participated in the development of the Core Principles. Together they offered a draft set of “Core Principles” for end-of-life care and distributed these principles to representatives of a number of medical specialty societies.
BASIC DOCUMENTS AFFECTING AMERICAN SOCIETY There are three basic documents which affect American society almost daily in day to day affairs. They are the Declaration of Independence, the Constitution, the Bill of Rights. Each The sentiments in favor of independence from England was growing in the American Colonies during the last days of 1775. The opening battles of the revolution, at Lexengton ...
Core Principles for End-of-Life Care Clinical policy of care at the end of life and the professional practice it guides should: 1. Respect the dignity of both patient and caregivers; 2. Be sensitive to and respectful of the patient’s and family’s wishes; 3. Use the most appropriate measures that are consistent with patient choices; 4. Encompass alleviation of pain and other physical symptoms; 5. Assess and manage psychological, social, and spiritual/religious problems; 6. Offer continuity (the patient should be able to continue to be cared for, if so desired, by his/her primary care and specialist providers); 7.
Provide access to any therapy which may realistically be expected to improve the patient’s quality of life, including alternative or nontraditional treatments; 8. Provide access to palliative care and hospice care; 9. Respect the right to refuse treatment; 10. Respect the physician’s professional responsibility to discontinue some treatments when appropriate, with consideration for both patient and family preferences; 11. Promote clinical and evidence-based research on providing care at the end of life. The medical societies listed below adopted the principles and or modified them to fit their specialty and individual patient’s needs.
American Medical Association Academy of Psychosomatic Medicine American Board of Hospice and Palliative Medicine American Academy of Hospice and Palliative Medicine American Pain Society National Kidney Foundation American Academy of Pediatrics American College of Surgeons American College of Physicians American Geriatrics Society Much of the strength of American medicine lies in the strength of the specialty societies. The awareness on viewing palliative care as a specialty for patients facing end- of- life has enlightened these specialty societies to make it priority to facilitate these principles.