“Palliative care is the care of patients suffering from a variety of illnesses whose diagnosis is limited. Its focus is intensive physical and psychospiritual care, including planning for the support of family members after death. Because of its complexity and intensity such care is best delivered by an interdisciplinary team.” (Latimer 1989) The purpose of palliative care is to treat the symptoms and needs of the patient and family/caregivers to allow the patient to have an improved quality of life, irrespective of how long that may be. Comfort measures are a part of this care which involve treating and controlling symptoms that are a part of a life-limiting disease. The current patient population is presenting healthcare professionals with more complex issues than seen in previous generations. Technology has allowed patients with COPD, heart disease, diabetes and related conditions to live longer with treatment; however, an extended longevity may not always be the best course of action. All too often elderly patients have their life functions extended by technological means; a ventilator breathing for them, drugs keeping the heart beating, enteral nutrition, a foley catheter to drain the bladder…the list can go on indefinitely. Their families camp out in the ICU waiting room, going in at the appointed visiting times and usually just sitting there, watching and occasionally speaking in hushed tones, listening to the monitors, IV pumps and the whoosh of the vent as it moves air in and out. The patient is attached to wires and lines, sometimes restraints, never moving or uttering a sound. The patient may or may not have adequate pain relief and sedation to keep them comfortable during this therapy, it is up to doctors and nurses to decide. For a fortunate few, when death comes they have someone there, often it is the nurse; but, for the vast majority they die alone with a monitor recording a slowing heart that becomes a flat line. Family is called, tubes and lines removed so a brief look can be had and the mortician is called for a pick up. For the majority of people, this is how their life will end; a cold, mechanical process that dehumanizes the dying individual, removing emotional and personal aspects; comparable to turning off the lights.

  How can a society which thinks of itself as the most advanced in the world allow this to happen? Do physicians and nurses lose their ethical perspective once a patient becomes incurable? Have they put aside nonmaleficence and justice when death becomes a factor? “Healthcare professionals are sometimes reluctant to diagnose dying, as they have not been trained to care for dying patients and therefore feel helpless.” (Ellershaw 2003) “Ensuring a good death for all is therefore a major challenge not only for healthcare professionals but also for society.” (Ellershaw 2003) Educating healthcare professionals on end of life care and life limiting conditions is key to changing how Western society treats the needs of incurable patients and their families.

  In order to incorporate new standards of care and practices, the financial impact must be evaluated. Research is demonstrating that early intervention and use of palliative care “reduces direct costs for both hospital and payers.” (Fine 2004) A sad fact is “that more than half of the elderly population has an income of <$20,000 and spends >25% of it on health care.” (Fine 2004) In addition to the increasing cost; consumers, insurance and healthcare are beginning to consider if available resources, technically and financially, are being used efficiently. “Spending more money does not necessarily lead to improved results. Researchers at Dartmouth Medical School demonstrated that some regions of the country spend 1.6 times more money per Medicare patient than other pars of the country, yet the increased spending does not lead to better quality of life or longer life.” (Fine 2004) East Tennessee and Appalachia fit into this category due to the high level of poverty, lack of healthcare access and a population with a high number of risk factors. Another study, Clinical and Economic Impact of Palliative Care Consultation, followed 304 patients (n = 1,813) who received palliative care consultations and care and compared the cost of treatment to standard care practices. “Compared to matched controls without palliative care consultation, palliative care cases had lower cost per day ($897 vs. $1004, P = 0.03). Per diem variable costs were 10.7% less for all palliative care cases and 20.5% less for those with >50% hospital days with palliative care consultation. Palliative care consultation is followed by decisions to forego costly treatment and improved symptom scores, and earlier palliative care intervention results in greater cost-savings.” (Hanson 2006) Obviously, eliminating unnecessary tests and treatments will drastically reduce the cost of care and allocation of resources.

<< Previous    1  [2]  3  4  5    Next >>