An unsurprising report finds that terminally ill people often procrastinate in entering hospice, and as a result, don’t receive the full benefit of this beneficent form of care. From the story:
Americans tend to procrastinate when it comes to matters involving death and dying, but a Harvard Medical School study published yesterday finds that even many terminally ill patients and their doctors put off conversations about end-of-life choices.
The study, one of the largest to date on the issue, found that only about half of the 1,517 patients with metastasized lung cancer who were surveyed had discussed hospice care with their physician or healthcare provider within four to seven months of their diagnosis. The vast majority of such patients do not survive two years.
Hospice care—which can be delivered in a home, hospital, or other facility - focuses on managing a patient’s pain and emotional and spiritual needs, rather than trying to cure the terminal illness...The longer a terminally ill patient expected to live, researchers discovered, the less likely the subject was to come up.
“Patients who had unrealistic expectations about how long they had to live were much less likely to talk about hospice with their doctor,” said Haiden Huskamp, a Harvard Medical School associate professor of healthcare policy and the study’s lead author.
There is a good remedy for this very real problem: Stop forcing patients to make a choice between hospice and the possibility of life-extending treatments. When I interviewed the great founder of hospice, Dame Cecily Saunders, she told me that forcing patients to make such choices is like saying to them, “Abandon hope, all ye who enter here.” In the UK, she said, patients can choose hospice understanding that if a new treatment comes along or they want that last life-extending dose of chemotherapy, they can have it. She suggested that the result was a much higher participation in UK hospice than that in America.
She is right. It would be both humane and cost effective, since once in hospice, she reported, most patients were so pleased they didn’t opt for treatments that would cause difficult symptoms. But knowing they could made people more likely to choose hospice—and doctors more likely to bring the matter up.
