Local - End-of-life care lacking: report

End-of-life care lacking: report May 22, 2010 Carmela Fragomeni The Hamilton Spectator (May 22, 2010) Despite years of complaints, end-of-life care remains an inadequate patchwork. A Canadian Cancer Society report this week focused on poor palliative care throughout the country. Help for dying at home is insufficient, and where other services do exist, as in Hamilton, patients are referred to palliative care too late. Care for the terminally ill is just as fragmented in Hamilton, according to researcher Dr. Kevin Brazil at St. Joseph's Healthcare. This, despite five area hospices attending to the dying and their families, the existence of hospital palliative care teams and of home support from local agencies.

"There's some real gaps and inconsistencies on how end-of-life care is delivered," says Brazil.

The number of hospice beds and quantity of home care are insufficient, and in hospitals, end-of-life discussions are missing among staff and families.

An average of four or five people a week die waiting for quality end-of-life care at Hamilton's Dr. Bob Kemp Hospice, said executive-director Beth Ellis. The hospice and one each in Burlington, Grimsby, Niagara and Brantford are five of Ontario's 19 hospices but together have only enough beds to serve a population of 1.2 million.

In nursing homes, a research paper by Brazil and colleagues found serious barriers to palliative care, and at Hamilton Health Sciences, which runs five city hospitals, few patients die under the care of its palliative team.

About 2,000 people a year die in HHS hospitals -- over 80 per cent from chronic and degenerative diseases like cancer and congestive heart failure, according to HHS ethicist Andrea Frolic.

They could benefit from end-of-life care but often don't get it, which is why HHS initiated a plan six months ago to help hospital staff discuss end-of-life wishes with patients and family.

"One of the barriers is it's emotionally difficult for health care professionals to deliver the bad news that a patient is not expected to survive," Frolic said. "There are huge cultural barriers in our society about talking about death. This normalizes it and gives people tools to deal with it."

The cancer society says most patients want to die at home, but more than 55 per cent of all deaths in Canada occur in hospitals, a sign of problems with supports.

This could get worse as cancer cases increase as the population grows and ages.

"One of the challenges we have is that the system is fragmented and this creates barriers to accessing good quality end-of-life care so people can die with dignity," says the cancer society's Sarah Bouma. Cancer is the leading cause of death in Canada.

A special Senate committee reported uneven access to palliative care in 1995 and a 2005 followup found little progress.

cfragomeni@thespec.com

905-526-3392

via thespec.com

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End-of-life spiritual satisfaction could lead patients to choose hospice care

mcknights.com

End-of-life spiritual satisfaction could lead patients to choose hospice care - McKnight's Long Term Care News << Return to End-of-life spiritual satisfaction could lead patients to choose hospice care, study finds End-of-life spiritual satisfaction could lead patients to choose hospice care, study finds December 21 2009 Patients nearing death are much more likely to opt for hospice care—forgoing aggressive life-prolonging treatment—if they feel they've made their peace with God, a new study shows. In a survey conducted by the Dana-Farber Cancer Institute in Boston, terminal cancer patients ranked pain management and spiritual support as the two most important end-of-life considerations. On average, patients who felt that their spiritual needs had been met were three-and-a-half times more likely to accept hospice care. Among the highly religious, spiritual satisfaction was five times more likely to end in hospice care. But only 60% of those surveyed felt their religious needs had been met, according to the study. Churches don't often provide theological guidance on end-of-life issues, leaving many to believe they should always keep hope and give God the chance to perform a miracle, according to one theologian who commented on the study. Additionally, physicians are often uncomfortable in the role of spiritual adviser. With better spiritual engagement at the end of life, terminal patients can understand that forgoing aggressive treatments and opting for hospice care is not necessarily against their religion. The study appears in the Dec 14 online edition of The Journal of Clinical Oncology.

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Who needs hospice volunteer training?

I am enthusiastic about the hospice volunteer training - even if the student never becomes a volunteer.

The concepts of hospice affect more than just the people experiencing a life limiting illness.  They
affect those with a life enhancing attitude.

It is my wish to assist all hospices in developing training for their volunteers in a cost efficient manner.  However, I don't believe it should be limited to hospices.  Funeral homes, assisted living facilities, personal care homes, hospitals and skilled nursing facilities deserve a site of their own just as I design for the individual hospices if they want to train staff regarding the hospice philosophy of care.

While many of us face death routinely, their are just as many of us looking for ways to really live life to the fullest. 

Please contact me if you would like to set up a site for your facility for training 10 or more of your staff throughout the year in hospice basics.  I don't charge for the site.  The cost is based on a per student basis.  Charges are $10 per person per year.  Go to:  http://volunteertrainingonline.com/courses and try it for yourself. $10 is a cost efficient way to discover a set of learning modules that can greatly enhance the effectiveness of your team.

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