One Slide for End-of-Life Conversations

So, for all of you who are already gathering with loved ones this holiday weekend, why not take some time to discuss your wishes for end-of-life care?

Engage with Grace has put together a helpful, simple, five-step slide to start the conversation.

New York Advance Cancer Patients More Likely to Die in ICU

A study just published by Dartmouth College shows that advance stage cancer patients in New York state are more likely to die in an ICU than the average patient nationwide. In New York, more than 46% of these patients are dying in ICU, compared to 29% nationally.

The ICU care costs more and is a greater drain on state resources, and these cost issues are forcing the Healthcare Association of New York State to take notice of this disparity. So, we may have a case in which a bankrupt healthcare system is pushing us toward better end-of-life care for patients, in some instances. I think this section of the article sums the issue up nicely:

"Under pressure to cut costs, New York's hospital industry is finally welcoming a new focus on palliative care.

That means letting patients and their families know when medicine has reached its limits and spelling out the options, which include foregoing drastic interventions that would cause patients to spend their last days in expensive intensive care. Recognizing it's a sensitive issue, hospitals are making a point of saying they do not prevent patients from choosing interventions. The idea is to help people make the best choices for themselves, said Dr. Tia Powell, a medical ethicist at Montefiore Medical Center in the Bronx."

Personalizing your "deathbed"

A fascinating article from the New York Times about people going to major lengths to create a personalized space in which to die. The individual examples are fun to read through. But more than that, I think this article is yet another reminder of the beautiful work that hospice caretakers and social workers do for the sick and dying every day. Because these scenarios would not be possible without their help.

P.S. This photo is just about my absolute nightmare scenario for where I could be when I die. Am I alone in this?

(Photo from NY Times.)

Top 50 Nursing Assistant Blogs

Much thanks to NurseAssistant.org for including The Good Death in its listing of the Top 50 Nursing Assistant Blogs.

I am happy to be in such great company. If you scroll down the list to Hospice Care Blogs, you will see us listed amongst some of the best palliative-care focused blogs out there.

Thanks for the shout out!

Hospital Type and Likelihood of Feeding Tube Use

A new study published in the Journal of the American Medical Association suggests that nursing home residents with advance dementia have starkly different odds of being given feeding tubes depending on which hospital they are sent to.

According to the study, some hospitals used feeding tubes in as many as 1 in ever 3 patients, while other hospitals used feeding tubes in as few as 1 in ever 100 patients.

Not surprisingly, hospitals that were more aggressive about providing end-of-life care were more likely to insert feeding tubes. Also, likely to use them were large hospitals and for-profit hospitals.

The sad implication of this study is that it suggests hospital protocols become more important in deciding end-of-life behaviors than family and patient wishes.

Here's a link to the JAMA abstract.

End-of-Life Planning

Carla from Compassion and Choices raised an excellent point in the comments of another post. End-of-Life planning is rarely straightforward, and it's important to fully understand all sides of an issue before you make important decisions.

There are some potential flaws in the simplicity of the Five Wishes format (a form I previously blogged about). Barbara Coombs Lee has written a nice piece about it. While its clever branding makes it memorable, and the positive framing of "wishes" is a nice language to cast death planning within, the form does have bent toward prolonging life that will not work for everyone.

The form does not allow doctors to withhold any treatment with the intent of taking your life. And it could be argued that many such behaviors than would be spelled out in a living will or advance directive could be cast as taking a life.

I'm a firm believer that any planning is better than no planning because, at the very least, you're giving your loved ones some indication of your wishes, fully understanding the implications of the forms you are working with is important to having the kind of death you would like.

Palliative Care Grand Rounds

Hi all!

Another edition of Palliative Care Grand Rounds is up at Alive Hospice Blog. It's a great overview of what has been going on in the world of palliative-care-related blogs.

Check it out!