New Reports: Caregivers, Doctors and Patients on Dying

Nearly two-thirds of Americans [PDF] believe the law should empower terminally-ill, competent patients to choose how they will end their lives. Yet, the AMA’s (American Medical Association) outspoken opposition to aid in dying has been cited by the Supreme Court and influences lower courts, state medical societies, and most important, legislatures.

The AMA claims to speak for doctors, and the media often echo that assertion, yet barely a quarter of the nation’s physicians are AMA members. Many medical and public health organizations have policies that support aid in dying, including the American Medical Women’s Association, the American Medical Student Association, the American College of Legal Medicine and the American Public Health Association. Still, according to a study recently conducted by Georgetown University Hospital, nurses, doctors and patients all feel some frustration, fear and abandonment during the end-of-life cycle for a patient in a hospital setting.

Nurses, in particular, who completed an End-of-Life Nurse Consortium Course, were asked about their training. Surprisingly, about 52 percent of nurses in the study said they never received this training, yet 43 percent reported they had been involved in one to three end-of-life situations within the previous six months.

Over 100 nurses attended the course, and while survey results are still pending, there have been some changes. All newly-hired nurses at the hospital now receive the training, and all of inpatient oncology and hematology nurses are required to take the end-of-life training course. The study found nurses that receive end-of-life education and training can positively impact the lives of patients and families facing difficult times, according to the report at WFTV. According to the news story:

Another study shows patients who are dying and their families report that feelings of abandonment by their physicians at the end-of-life have two components: a loss of continuity of care before death and a lack of closure near death or afterward. “Early on, patients and family caregivers fear that their physician, whose expertise and caring they have come to depend on, will become unavailable,” the authors write. Most physicians are not consciously aware of having abandoned their patients. Instead, they report lack of closure or a feeling of unfinished business. The report could help physicians structure care to maintain the professional value of non-abandonment, including use of non-hospice palliative care or closure-promoting communication strategies involving nurses and other members of the health care team. As end-of-life approaches, physicians should offer assurances that they’ll still be available and should maintain contact with the patient and caregiver, according to Anthony Back, M.D., of the Seattle Cancer Care Alliance, and colleagues.

Interestingly, patients with advanced cancer who discuss end-of-life care with their physicians appear to have lower health care costs in the final week of life than those who do not, according to a report in the Archives of Internal Medicine. Formal and informal caregivers who were interviewed after the patients’ deaths reported that those with higher costs also had a worse quality of death in their final week.

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