London, February 09: Neither patients nor doctors want to hear about the former dying, however doctors are now being asked to be more frank about reality, helping patients come to terms with their illness sooner, and perhaps come to find peace sooner.
Oncologists are now saying, far more often, that doctors aren’t being as direct with their patients as they could be, delaying news of other options such as comfort care or acknowledging that chemotherapy has become futile until the end.
To aid families in such a grievous time, the American Society of Clinical Oncology has published a booklet informing family members and patients about their options on maximizing the remaining time.
Dr. Allen Lichter says that such news should not be given in the back of an ambulance rather it should wait until everyone “has their wits about them” before beginning the important process. The actual information booklet can be found at cancer.net. It’s an unusually intensive care program that greatly emphasizes end-of-life care and comforting patients. Known more for it’s force in fighting tumors, oncology seems to show a more comfort-oriented side which has always been present but which now is being urged to develop.
The guidance also stresses the importance of doctors ceasing difficult treatment when this becomes futile and concentrating more on symptom relief and psychological care of the patient, all throughout the illness.
It’s a subject so Taboo, however, that in 2009 when Congress tried to encourage such acts of humanity towards dying patients, they were accused of creating “death panels”.
Closure, which is a program developed in Pittsburgh, deals with these sort of problems. It encourages families to talk with one another, comforting and giving advice where it is meant to be given. It is a program which was started by the Jewish Healthcare Foundation and has quickly spread into many hospitals.
These sort of frank, direct sessions find themselves having doctors talking to patients about resuscitation preferences, were they to go into shock or a coma and their relatives not be aware that they were actually that ill.
Dr. Jonathan Weinkle, a physician who works in the program, says that over the coming years, more and more people will ask of their doctors that they ensure them a painless death, not surrounded by lights and sirens or people pushing down on their chests. It’s normal to want a proper death and not a moment too soon, says Dr. Weinkle.
Pearl Moore, another participant in the program, says that people would be much better off talking about these things before they are ever sick, because it’s much easier to plan before.
With her mother having died of stomach cancer, Moore was haunted by the fact that her family never had the option of discussing these things and discussing an alternative means of spending the remainder of the time. She returned to college to pursue training in nursing cancer sufferers. She stressed the need for people to “live until they die”.
A few years ago, Moore had already written her living will and healthcare plan, giving a copy of these instructions to her daughter once she was grown.
Although Moore is an example of fore-planning, not nearly enough people think of such things when they are still healthy.
Oncologists are saying that patients aren’t having realistic conversations with their doctors, planning their treatment as their illness will progress.
The consequences of such poor decision making, are the traumatic last few weeks of patients’ lives. Not enough patients are being told that chemotherapy and other, expensive, side-effect-prone treatments will buy at most a few months. This leaves patients hospitalized, moved between operating rooms and vomiting from chemotherapy in the last stages of their disease.
Most patients feel that treatments which offer them relief from symptoms such as nausea and shortness of breath mean giving up when they should be getting tumor-killing treatments.
In one case, a man suffering from lung cancer, made over 20,000 dollars in hospital bills, spending his last few days on a ventilator because his family had called 911 after he began experiencing shortness of breath. Doctors feel that this symptom could have been treated at home, keeping the comfort and avoiding colossal hospital bills.
Doctors hope to implement more of these conversational programs in more hospitals by summer. In the meantime, doctors have a few points of advice they wish to give patients: Always talk with your doctor about treatment options, quality of life, risks and benefits regarding any new medication as you can change your mind at anytime. Ask for more information about symptom relief along with your chemotherapy. Make sure you clear up details regarding your living will as this will help carers and family understand your wishes even when you cannot communicate, this refers to such things as a feeding tube, etc. Most experimental trials will not accept patients that have been under other types of treatment, so it would be a good idea to consider such options in an earlier stage.
–Agencies–