The Hospice e-News

What the Media Said about End-of-Life Care This Week

Week of August 1, 2006

…a service of Florida Hospices and Palliative Care

 

 

PROTOCOL HELPFUL IN DELIVERING BAD NEWS TO PATIENTS

 

Dr. Rhonda Fishel had participated in the delivery of bad news to patients as physician and as a supportive friend,  Fishel has also been a patient who received bad news and says that she’s convinced that patients remember less about their diagnosis than about how the doctor broke the news to them.  An article in The Baltimore Sun quotes her as saying, “You go into these rooms knowing that you’re going to destroy people’s lives, [but] I never understood what it felt like physically, until I had to go through it.  It’s like a pain in your chest.”  She knows of colleagues who stand in the door of a patient’s hospital room to deliver bad news and then quickly leave.

 

Other physicians, concerned with the same phenomenon, have developed a protocol that “acknowledges the fact that giving bad news is very hard and doctors aren’t taught those skills.”  Dr. Walter Baile, a psychiatrist at Johns Hopkins Bayview Medical Center, and Dr. Robert Buckman, of Toronto’s Princess Margaret Hospital, developed the SPIKES protocol, an acronym for “Setting, Perception, Invitation, Knowledge, Empathy and Strategy/summary.”  These, they say, are components of importance when sharing diagnosis with patients.

 

Baile says that physicians should take their time when giving bad diagnoses to patients and should make sure patients understand what’s being said to them.  Choosing a location that’s comfortable for the patient is also important, but the most important thing is to empathize with the patient.  “I can see you weren’t expecting bad news,” or “I wish there was something I could do” are good statements.  “There’s nothing I can do” is not good, he said, because “that’s abandonment.”

 

Fishel uses the SPIKES protocol when speaking to young medical students, but Baile believes that the students don’t have the experience to “put SPIKES into context.”  He thinks they can learn it, but questions whether they retain it.  Jay Bhatt, president of the American Medical Student Association, disagrees with Baile, saying, “I don’t think it’s ever too soon to understand human interactions, human emotions and how that impacts people’s health.”

 

Dr. Jacek Mostwin teaches a course called “Patients, Physicians and Society” at Johns Hopkins School of Medicine.  He says, “The initiative should expand across the entire spectrum of physicians.  You need to introduce it at all levels, but it needs to be proportionate to the experience people have.”  Students at the University of Maryland School of Medicine encounter end-of-life issues in their first two years, begin visiting hospices in their junior year and receive formal training in protocols such as SPIKES only when they become residents.  Maryland’s Dr. Douglas Ross says that his school’s philosophy is, “The medical students will often be taught by the residents, and we will not graduate residents unless they complete this training.”  (The Baltimore Sun, 7/28)

 

 

STATES AND EMPLOYERS DEVELOP AID FOR CAREGIVERS

 

Two recent articles focus on support for caregivers.  The Sun-Sentinel examines ways in which states are making it easier for caregivers to take time off.  The Wall Street Journal looks at employers’ efforts to support working caregivers.

 

The Sun-Sentinel reports that, two years ago, California began a paid family leave program for caregivers.  More than 20,000 people took advantage of it in the first year.  Workers pay a small amount per paycheck – no more than a total of $63.53 per year – to the State Disability Insurance program.  If they need it, they can collect 55% of their salary each week, up to a maximum of $840 per week for six weeks.

 

Eight states are considering active bills that deal with family leave.  Washington and Illinois are looking at insurance programs.  Hawaii and Minnesota may redefine their definitions of sick leave.  Paid-leave benefits are under consideration in Massachusetts and New Jersey.  New York may let workers defer part of their paychecks, tax-free, to cover salary during family leaves.  Pennsylvania is considering tax credits for employers offering family leave.

 

Gail Hunt, president and CEO of the National Alliance for Caregiving, says that the key is figuring out how to help working caregivers and also support their employers, who need to keep their businesses running.  Paid leave for caregivers helps both employee and employer.  Surveys show that when employees get full pay during caregiving leaves, 94% return to their same jobs.  Seventy-six percent of those who take unpaid leaves do not.  (The Sun-Sentinel, 6/12)

 

The Wall Street Journal says, “Companies are increasingly helping employees by adding workplace benefits similar to those that have been offered for child dependents.”  Some examples include:

 

*  Prudential Financial Inc.  For a $100 co-pay, workers can have a geriatric care specialist visit an elderly parent and draw up a care plan or evaluate a nursing home, even out of state.

          *  McGraw Hill.  The company allows employees to enroll one other adult family member on a worker’s health insurance at regular rates.

          *  Verizon Wireless.  It has been offering emergency in-home care to full-time employees and has extended it to some part-timers.

          *  Mellon Financial Corp.  Mellon contracts with Caregivers on Call to supply emergency services for elderly relatives of employees.

*  Alston & Bird LLP.  The law firm has a catastrophic leave-sharing program in which employees can donate unused vacation time to other employees who are caregivers but have used up their own leave time.

 

Even though some companies are cutting back benefits in other areas, such as healthcare coverage, because of rapidly rising costs, some cost-effective benefits are being added.  Programs to assist with family issues and help employees stay healthy “are gaining increased attention.”  Corporate clients are demanding more elder care options from the companies that provide such services.  (The Wall Street Journal, 7/27)

 

 

PAIN NOTES

 

*  In the August issue of Arthritis & Rheumatism, researchers report that low blood levels of two cytokines, IL-4 and IL-10, could be key to understanding chronic pain.  Low levels of the two proteins were found in patients who had widespread pain.  Previous studies have shown that both can reduce the body’s sensitivity to pain.  The researchers say, “The low levels of IL-4 and IL-10 we observed in the patients … might be caused by genetic alterations either in the cytokine genes themselves or in regulatory elements, although other factors may be involved.”  (HealthDay News, 7/26)

 

*  A study published online in Neuroscience, and expected to be in the August print issue, reports that researchers have identified a protein in nerve cells that may be a gatekeeper for chronic pain.  Protein kinase G (PKG) “is turned on and activated in response to injury or inflammation,” the HealthDay article says.  “Once activated, PKG triggers other processes that generate pain messages that are sent to the brain.  As long as PKG is switched on, pain persists.  Turning PKG off relieves pain.”  Researcher Richard Ambron, of Columbia Medical Center in New York, says, “We’re very optimistic that this discovery and our continued research will ultimately lead to a novel approach to pain relief for the millions suffering from chronic pain.”  (HealthDay News, 7/28)

 

*  During Pain Awareness Month this September, the American Society of Pain Educators (ASPE) will offer several educational events on pain management education for healthcare providers.  Clinicians who are interested may register for a free informational resource guide and specific Pain Awareness Month events by call 888-ASPE-REG or visiting www.painawareness.org.  (PR Newswire, 7/26)

 

 

RESEARCH AND RESOURCE NOTES

 

*  The website of the Oklahoma Palliative Care Resource Center has sections on Oklahoma law, palliative care, news and events, book reviews, advance directive acts and forms, and links to other resources.  See okpalliative.nursing.ouhsc.edu.  (Oklahoma Palliative Care Resource Center Website)

 

*  An article in The Washington Post says, “A small but growing body of research shows health disparities between native-born blacks and foreign-born blacks living in the United States.”  The study, originally published in the Journal of Health Care for the Poor and Underserved, says that newly arriving black immigrants have “lower rates of cardiovascular disease, cancer, hypertension, obesity and overall chronic medical conditions” than blacks born in the US.  But after years of residence, those differences lessen, which concerns both health researchers and immigrant advocacy groups.  One researcher says that much research doesn’t differentiate between blacks from Africa, Central and South America and many islands, but that blacks “in this country are not a homogenous group.”  (The Washington Post, 7/25)

 

*  Two-thirds of married people choose their spouse as a proxy for medical decision-making, but a female relative is most often selected by the other one-third.  A study on advance care planning by Dr. Michael Lipkin of Northwestern University found that adult patients who do not choose a spouse usually prefer mothers, sisters or daughters over fathers, brothers and sons.  See www.seniorjournal.com/NEWS/Features/6-07-26-FemaleRelativeMostOften.htm for the story.  (Senior Journal Website, 7/26)

 

*  A new Mayo Clinic study, recently published in Mayo Clinic Proceedings, says that today’s 30-40% of hospital costs that go to intensive care may rise as the population gets older.  Dr. Edward Seferian, first author of the study, says that the results highlight the importance of discussing end-of-life preferences with patients.  He also noted that funding for end-of-life care should be carefully considered by healthcare policy makers, since expanding nursing homes or hospice care might be a more cost-effective way to spend federal money.  (Physician Business Week, 8/1)

 

 

OTHER NOTES

 

*  Dr. Joanne Lynn, senior scientist at the RAND Corporation, recently spoke to physicians and medical students at the University of Oklahoma Health Sciences Center on the topic “No One in the Bible Died Like This.”  Lynn noted that two-thirds of Medicare expenditures go to people with five or more chronic conditions and that 83% of the people who die in the US are using the Medicare system.  But, she says, the system was conceived of and planned around 50-year-olds, so is “well-structured for tests, surgical interventions and in-patient treatments for conditions that can be cured.”  The people who could call for reform and change in end-of-life policy are caregivers, Lynn said, and any march by them on Washington would have to be a virtual one because they are busy taking care of their loved ones.  (The Oklahoman, 7/24)

 

*  In “Medical Care of Adults with Mental Retardation,” authors Christopher D. Prater and Robert G. Zylstra say, “Persons with mental retardation are living longer and integrating into their communities.”  Though conservators are usually appointed for mentally retarded adults who cannot make medical decisions for themselves, those conservators may not make living wills for their patients.  The authors suggest “individual and family preferences about treatment objectives and parameters for resuscitation efforts can be documented to help guide surrogate decision makers in their absence.”  (American Family Physician, 2006;73(12):2175)

 

*  The Wall Street Journal says that as Congress fights over immigration, many think of low-skilled foreign labor as the people who bone the chickens, mow the yards and fold the laundry.  But “the issue cuts into something more basic:  a demographic thundercloud moving over the country as baby boomers age.”  Immigrants, both legal and illegal, “make up a disproportionate share of those who care for the elderly – and the need for such workers is set to explode in the coming years.”  Some experts say that some of those workers will have to come from abroad.  (The Wall Street Journal, 7/26)

 

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2006.  Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division.  Ask your insurance agent to visit their website at www.hccis.com.