End of Life, EOLPodcast, Hospice

Ep. 62 October End-of-Month Update – Halloween Edition

 

Dr. Wyatt thanks her newest Patreon.com supporter Tracy Zagata. You can become a supporter as well by going to Patreon.com/eolu and signing up!

Sign up for Death Expo which will take place Nov. 10-13, and hear 12 speakers on EOL issues. Go to DeathExpo.com to register free to tune in to these excellent presentations.

This episode is taking place on Halloween and the Day of the Dead. Dr. Wyatt includes the following updates:

  • CMS report 52% increase in Medicare spending on hospice between 2007 and 2015 due to 38% increase in the number of patients receiving hospice care, primarily patients with dementia
  • the DEA is mandating 34% decrease in opioid production due to dramatic increase in opioid-related deaths since 1999 – rate has quadrupled during that time frame
  • JAMA Oncology reports that the cost of secobarbital, the drug most frequently prescribed in assisted dying cases, has increased by $25oo; there is no explanation except that drug companies can get away with it
  • California is the first state to require that palliative care teams have a chaplain for those patients who want to receive spiritual care
  • Debra Beaulieu writes in HealthLeaders Media that all clinicians should know the following about palliative care: 1) that it’s not just for dying patients 2) that it is often underutilized and 3) all clinicians should have basic palliative care skills
  • Study in J. Palliative Med showed that home-based palliative care (as opposed to hospital-based care) meets more of patients’ needs in the last 3 months of life and costs $12,000 less per patient
  • Controversial “doll therapy” for dementia patients
  • Study shows that 11% of female caregivers over the age of 50 have to leave their employment to fulfill caregiver duties, costing $300,000 in lost wages, benefits, and Social Security over time
  • Census data reveals that currently 25% of seniors are considered “Elder Orphans,” meaning that they have no children or close family to care for them; these numbers will only grow as Baby Boomers age, reinforcing the need for more caregivers
  • Medicare Care Choice Pilot Program is currently underway; patients can receive home-hospice care while continuing curative treatments if they have a diagnosis of cancer, COPD, CHF, or HIV; there are 140 participating hospices in the program
  • Survey shows that 1/2 of MS patients would consider medically assisted dying in the case of unbearable pain, being a financial burden to others, or if unable to enjoy what makes life worth living
  • Study reveals the 69% of MOLST or POLST forms have incomplete information and 14% have conflicting choices, making them nearly impossible for care providers to follow
  • the nation’s first conference on VSED was held in October at the Seattle U. School of Law and was featured in an article in the NY Times. Phyllis Shacter was a speaker – you can hear her EOLU interview in episode 25
  • Conversation Sabbath will take place November 11-20 with >30 congregations from various faiths participating; the focus will be on EOL conversations and theconversationproject.org will provide tools and resources for the event
  • Andrew Henderson, 28 year old performance artist who is terminally ill has created an art performance called Taking it to the Grave and will tattoo the secrets of his audience on his body before he dies
  • Miss Norma, the 90 year old woman who chose to go on a cross-country RV tour with her son and daughter-in-law rather than undergo treatment for cancer, has died

Have a safe and meaningful Day of the Dead! Tune in every Monday for a new episode and support EOLU at Patreon.com/eolu. Until next week remember to:

Face Your Fears.                 BE Ready.                Love Your Life.

 

End of Life, EOLPodcast

Ep. 58 Why Some Doctors Struggle With the End of Life

Click here to read the companion blog on Huffington Post.

In this episode Dr. Karen Wyatt discusses the fact that according to the Nebraska End-of-Life Survey, even though 70% of patients surveyed want their doctors to discuss their end-of-life options but only 21% of them have actually had those conversations.

In addition, while 86% of doctors agree that they themselves would enroll in hospice if terminally ill, only 27% of them are comfortable discussing hospice as an option with terminally ill patients.

There is a huge disconnect between what patients want from their doctor and what they receive and also what doctors would do for themselves at the end-of-life and what they do for their patients.

Today’s conversation looks at reasons for this disconnect to point the way toward changes that are needed in how medicine approaches the end of life. Here are some of the attitudes and mindsets that make it difficult for some doctors to address death and dying, based on conversations between Dr. Wyatt and her colleagues:

  • “It’s not my job. My passion is for saving lives.” Ideally doctors must maintain their passion for life, but must also make room for death, since every patient will ultimately die. Doctors need to cultivate a view of life that includes the reality of death.
  • “I don’t have enough time and the end of life is less important than other issues I’m expected to discuss with patients.” The average primary care visit with an elderly patient last 15.7 minutes and covers 6 topics. Doctors need to view the end of life as the final stage of development and give it the same attention as the other stages of development.
  • “Death represents failure.” While death in general is a natural process and not a failure, for doctors the death of a patient can be a devastating experience, especially if it is unexpected. Doctors carry an enormous burden of responsibility for the health and wellbeing of their patients and mistakes can lead to complications and death. For doctors it is difficult to carry both responsibilities: to preserve life and promote health while also honoring death in its place.
  • “I don’t want to take away my patient’s hope.” Many doctors recognize that optimism and positivity are essential for a patient’s survival and wellbeing. But they view curative treatments as the source of that hope while failing to recognize that hope has many different meanings for patients. They promote ongoing treatment in order to keep hope alive while failing to offer emotional and spiritual support that can foster hope even in the face of death.

By recognizing the obstacles that keep doctors from engaging in end-of-life interactions with patients we can help overcome them over time. It’s important to have compassion for everyone involved as we try to move forward and evolve care at the end of life in our society.

You can support EOLU by making a small pledge of financial support ($1 or $2 per month) at Patreon.com/eolu. Be sure to tune in every Monday for a new episode, leave comments and write reviews on iTunes! Remember to:

Face Your Fears.           BE Ready.              Love Your Life.