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Making Better Choices for End-of-Life Care

 
                              
Most people in the United States who are Medicare eligible have a difficult choice to make when faced with a terminal diagnosis: continue with traditional medical treatment or switch to hospice care which focuses not on a cure but on easing their final days. In the past this choice often was an emotionally draining one for the patient and their families. Hospice care which requires a six month or less terminal diagnosis presents an excruciating choice between giving up hope on traditional treatment for a miracle cure and admitting that it was time to accept the inevitable. Death in our society has often been seen as defeat by medical doctors and patients, rather than a natural process that comes to us all eventually.
 
There is now anew pilot program with Medicare to allow both options. This new test program designed to affect the care of about 150,000 Medicare patients over the next four years, will allow patients with terminal diseases to receive hospice care to manage suffering and counseling to plan for the end of life — but still see doctors and get medical treatments, like chemotherapy or hospitalization, intended to fight their illnesses.
 
The new program is based on research that shows that patients with access to good pain control called palliative care and traditional medicine often end up with a better quality of life and less expensive, intense medical treatment. These results were found by using a randomized control study showing positive benefits to the approach. Dr. Jennifer Temel ,an author of a randomized study said she was sometimes asked why such a trial was needed for an idea that seemed intuitive. “But doctors are evidence oriented, she said, and the studies have provided a strong basis for changes in medical practice and payment policies from insurers like Medicare.”
 
Dr. Temel says, “ I think we need more of a gray zone where patients can get the benefits of hospice care but still receive chemotherapy to help them live longer.
 
However, a new study of 312 patients, published in the July 2015 issue of JAMA Oncology, which included patients with six months or less to live,  finds that half of cancer patients received chemotherapy in their final months of life, even though the therapy– which can cause nausea, vomiting and other grueling side effects – had no chance of curing them.
 
“Doctors often prescribe chemo to people in the end stages of cancer in the hope that the drugs will shrink patients' tumors and make them feel better”, said study co-author Holly Prigerson, co-director of the Center for Research on End-of-Life Care at Weill Cornell Medical College in New York. Her new research, however, found no evidence that chemo improved patients' quality of life. “For the healthiest, least disabled patients, quality of life actually got worse after chemo”, Prigerson said. That doesn't mean chemo has no benefit. Chemo can cure many types of early cancer. Even when chemo can't cure people, it can often give them more time. When one chemo regimen fails, a different kind may still give dying people extra months of life.
 
Often ignored are the complementary care treatments that can also afford some mental, physical and emotional comfort during the end of life. In my book Soul Service: A Hospice Guide to theEmotional and Spiritual Care for the Dying( Balboa Press, 2013) www.soulservice.info these complementary treatments like acupuncture , massage therapy, music therapy and pet therapy just to name a few proved beneficial in helping those facing their final transition. However, most hospices and hospitals underutilize these treatments.
 
Let’s hope the new Medicare pilot study will prove that there is room in traditional medical treatment of the terminal patient for both hospice and traditional treatment. It will be a great service to the American beneficiaries of Medicare for future years to come when our medical services can incorporate this knowledge into everyday end-of-life patient care. Perhaps one day they will also consider reimbursement for complementary care when a study can prove the benefits of these as well.
 
Christine Cowgill, MS, CRC is the Author of Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying (Balboa Press, 2013) www.soulservice.info .Christine is a certified rehabilitation counselor with over ten years of experience in medical and vocational case management. She is also a licensed life and health insurance agent. Visit Christine Cowgill’s Amazon author’s page for further information.  Christine has a Facebook page offering tips for caregivers at
 
 
 
 
 

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