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Reporting on a web-based
survey sponsored by NHPCO and PoPCRN, authors Stacy M. Fischer, Kathy Egan,
Cordt Kassner and Jean S. Kutner say, “Hospices provide a significant amount of
uncompensated education. This conclusion provides a unique opportunity
for hospices to collaborate with healthcare educational institutions and to
influence the work force of the future.”
Persons responding to the survey were asked
questions pertaining to educational opportunities offered to students in
medicine, nursing, therapies, pharmacy, counseling and social work, chaplaincy
and other healthcare vocations. The
questions asked about each discipline were the same and covered the number and
level of education of each student, the types of education offered by the
hospice and the nature of the hospice’s relationship to the academic
institution. Additional questions dealt
with which staff members were involved in student education and what the
benefits and burdens were of being involved in the
educational process.
Ninety-five percent of the 73 hospices that completed the survey participate in educational activities with students. Education was provided to almost all disciplines, but no hospice offered education to speech/language therapists, dental or chiropractic students. Most of the students were from medicine and nursing and the fewest number of students were from social work and therapies. Social work students required the most staff time during their rotations. Therapy and complementary and alternative medicine students required the least staff time. Medicine and nursing students fell in the middle with an average of 10-14 hours of staff time per week.
Fewer than 10% of the responding hospices had any sort of financial agreement with the educational institutions. Most had contractual agreements or informal arrangements. Thirty-six percent of the hospices had a separate education department and 27% a dedicated staff position for coordinating educational offerings. Staff members who provide hands-on care to patients, however, gave most training.
The hospices gave several reasons for
offering education to healthcare students:
1) They felt obligated or simply were asked to do so; 2) They saw it as
an opportunity to promote hospice; 3) It was a way to influence the training of
the students and to expand the workforce for hospice in future years; and 4) It
was part of the hospice mission.
The respondents also listed many benefits of their educational efforts. General benefits included changing cultural views about death, increasing awareness of hospice in the community and influencing knowledge of palliative care. Staff benefits included the opportunity of working with students from multiple disciplines. Patients were expected to receive better care as a result of positive experiences on the part of physicians participating in hospice education. Individual hospices benefited from additional referrals when the students entered practice, the possibility of future recruitment of hospice staff and utilizing the students as a source of inexpensive labor.
The major burdens felt by the hospices
related to staff time, but lack of funding was also cited. Concern for patients was also expressed, with
some being concerned about intrusion into a patient’s or caregiver’s life at a
vulnerable time. Others worried about
patients’ privacy.
The authors note limitations of the study and recommend more research in this area. But based on their findings in this project, they offer a number of recommendations, summarized in their conclusion. “Despite the significant time burdens reported by survey respondents,” say the authors, “hospices continue to provide largely uncompensated educational experiences to a wide range of healthcare profession students. To continue meeting the challenges of training these students in palliative care, alternative funding sources, academic partnerships, and support networks are needed.” (American Journal of Hospice & Palliative Medicine, 2005;22(1):32-40)
VERMONT AG
RELEASES REPORT ON PAIN & DECISION-MAKING
In A press conference by Vermont Attorney General William Sorrell (D) releasing his office’s report on end-of-life care, Sorrell encouraged physicians to aggressively treat pain without fear of prosecution, especially near the end of life. An AP report quotes Sorrell as saying, “We in law enforcement do not want to be second guessing medical professionals or going into medical files.” He called the message to medical professionals simple: “The issue is your intent. If your intent is to hasten death, that’s wrong and illegal.”
In 2003, Sorrell appointed two committees
to report on end-of-life care in
* New HHS Secretary Michael O. Leavitt wants to cut Medicaid payments for prescription drugs and give states new powers to “reduce or reconfigure benefits for millions of low-income people.” Leavitt says, “Medicaid is not meeting its potential. It is rigidly inflexible and inefficient. And, worst of all, it is not financially sustainable.” (The New York Times, 2/2)
*
PAS &
END-OF-LIFE NOTES
* An editorial in The Honolulu
Advertiser encouraged the legislature to “continue to work on state
legislation that addresses” the issue of physician-assisted suicide. The writer says, “Those who receive the best
pain management and palliative care tend to be those with resources and strong advocates.”
The writer notes that not all physicians have end-of-life care training. The editorial concludes by saying, “As
important as it is, however, palliative care is not a substitute for having
control over the time and place of one’s death, including who should be
present…” (The
* Meanwhile, the
* An opinion in The Arizona Republic says that the writer
cannot support the end-of-life legislation, proposed by state Representative
Linda Lopez (D-Tucson), offered in HB 2313 and HB 2311. The bills deal with PAS and pain
management. The writer believes that the
legislation should “spur discussion about the rights of the terminally ill... Lawmakers should hold hearings on these
proposals and begin the open exchange of ideas that will evolve into solid
public policy in the future. Perhaps the
bills themselves could evolve into a legislative study designed to involve the
public and hash out solutions.” The
bills may be viewed at the
* Talking to their terminally ill child about death “opened the door to loving conversations” between Mike and Kay Merrill and their son Gabe. An article in the South Bend Tribune interweaves Gabe’s story with information from recent studies about discussing death with terminally ill children. (Southbend Tribune, 1/23)
* A recent “Ethics
Forum” at American Medical News’ website focused on
* The movie “Assisted
Living,” which opened last week, is a lighthearted look at life in a nursing
home. It was filmed in a
RESOURCE AND
ARTICLE NOTES
* Articles presented as part of the Joint 2005 Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association include “Palliative Care Team Linked to More Satisfaction Than Usual Care,” “Research Identifies Areas for Improvement in End-of-Life Care” and “Illness Severity, Mortality Risk Best Predictors of Cancer Patients’ Referrals to Hospice Services.” Learn more about the presentations online at www.medscape.com/viewprogram/3782. A one-time free registration is required. (Medscape Website)
* A special report on medical bankruptcy is posted on the website of Health Affairs at www.healthaffairs.org/. Many people declaring bankruptcy are doing so because of medical bills and many of them are covered by insurance. Analysts say that the report underscores “the limitations of the nation’s current system of providing health insurance largely through employers.” Additionally, employers are increasingly shifting the burden of costs to employees through higher deductibles and co-payments. That practice, says the article, “may well exacerbate the problem of medical bankruptcies.” (The New York Times, 2/2)
* A special health report in US News & World Report looks at the changing roles of healthcare personnel. One article, “Nurses Step Up to the Front,” looks at the increasing role of nurses in responsibilities that were once only performed by physicians. “Doctors Vanish From View” examines the frustrations of physicians caught between high costs, low reimbursements and insufficient time to spend with patients. “Medicine’s Turf Wars” reports on the nurse practitioners, nurse anesthetists, dentists, chiropractors and other providers who are delivering more of the nation’s health care. (US News & World Report, 1/31)
* “More Nurses Needed,” an article in the US News & World Report special health report, says that in spite of job incentives for nurses that started in the 1990’s, the vacancy rate in 2020 will be 29%, up from 7% today. Enrollment in nursing schools would have to increase 40% annually just to replace retiring nurses. (US News & World Report, 1/31)
* “Family Privacy and Death – Antigone, War, and Medical Research” is the title of an article in the current NEJM. The article examines family privacy rights after the death of a person. Author George J. Annas discusses two cases in the political arena which impinge on privacy – photographing the coffins of returning servicemen at Dover AFB and the photographs of the scene of Clinton White House Counsel Vince Foster’s death. A third case concerns the creation of a DNA database of Icelandic families and whether informed consent is required. Annas says, “Protecting family privacy in the face of death will depend on how highly we value family privacy when weighed against competing values of society.” (NEJM, 2005;352:501-505)
OTHER NOTES
* David Gibbs, the attorney for Terri Schiavo’s parents, Bob and Mary Schindler, has asked Florida Circuit Court George Greer to allow him to proceed with a motion which argues that because Schiavo never had her own attorney, her due-process rights were violated. Greer gave Gibbs until February 7 to file more written arguments and said that he would decide a few days later about whether or not the court will hear the issue. (AP, 1/29)
* Maia Szalavitz, a senior fellow at media watchdog group STATS.ORG, says that pain sufferers who have had their COX-2 inhibitors recently pulled from the market should consider opioids. Szalavitz writes that “media hysteria and government paranoia over their addictive properties have frightened both doctors and patients alike… Not only are they the most effective painkillers, they are also among the safest drugs on offer. Taken as directed, their most significant side effect is constipation, and possibly flu-like symptoms if they are discontinued too abruptly… The fears about using opioids for pain relief stem largely from the dangers of recreational use.” (New Scientist, 1/29)