Will Hospice Shorten Your Life?

images-1Many of us might believe that when we choose to accept hospice care at the end of our lives, our lives will be shortened as a result. After all, hospice patients often stop painful chemotherapy or other interventions that are expected to prolong their lives.

But a number of studies have proven this not to be true. A landmark study from the Massachusetts General Hospital in 2010 made some startling findings. Researchers randomly assigned 151 patients with Stage IV lung cancer to two possible approaches to treatment. Half received the usual oncological care. The other half received the same oncological care with additional visits from a palliative care specialist. These specialists focus on preventing and relieving the suffering of patients.

Those who saw a palliative care specialist chose to stop chemotherapy sooner, entered hospice far earlier and experienced much less suffering at the end of their lives. And they lived 25% longer that those who did not receive palliative care!

Atul Gawande, M.D. ,in his groundbreaking book, “Being Mortal”, states that “Like many other people, I had believed that hospice care hastens death, because patients forego hospital treatments and are allowed high-dose narcotics to combat pain. But multiple studies show otherwise.”

He adds, “For some conditions, hospice care seemed to extend survival. Those with pancreatic cancer gained an average of three weeks, those with lung cancer six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer when you stop trying to live longer.”

Gawande, a practicing physican in Boston, reports that most terminally ill cancer patients have had no discussion with their doctors about their goals for end of life care despite being within months of death. But those patients who enrolled in hospice, suffered less and were better able to interact with others forlonger period of time. “People who had substantive discussions with their doctor about their end of life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.”

Does your Mom need Palliative Care?

A very interesting article appeared on the front page of the New York Times yesterday (April 4, 2010) It was  about Dr. Desiree Pardi,  a leading practitioner of palliative care, one of the fastest growing fields in medicine. Palliative care is the counseling of terminally ill patients regarding their end of life choices. Unfortunately Dr. Pardi contracted terminal cancer and had to choose whether or not to receive palliative care herself. Ironically she chose not to, but rather decided to fight her illness aggressively until the end.

Palliative care has become the standard practice of most hospitals in the country. It’s popularity is a backlash against the harsh, sterile treatment of patients at the end of life that had been practiced in so many hospitals. It stresses the relief of pain, and recognizing that after a certain point, aggressive treatment may prevent patients from enjoying what time they have left.

Dr. Pardi chose to believe that her Doctors underestimated her and that she could fight and win the battle against cancer. But she died a very painful death after extensive chemotherapy and other experimental treatments. She died before many of her colleagues could say goodbye and they grappled with her death. Some said she took the right course fighting her illness to the very end. Others said that she was in a state of denial and refused to accept her impending death.

At what point would you recommend to your own parent that she receive palliative care? It is a very difficult decision and should be discussed prior to the time when a decision has to be made. Have you discussed your parent’s advanced directives with them, their health care proxy, their living will and their power of attorney?

An excellent alternative to the traditional health care proxy and living will is the Five Wishes program. Each individual goes through a form which asks detailed questions regarding how they want the Five Wishes to be carried out. It is available through www.agingwithdignity.org

Wish 1: The person I want to make health care decisions for me when I can’t make them for myself.

Wish 2: My wish for the kind of medical treatment I want or don’t want.

Wish 3: My wish for how comfortable I want to be.

Wish 4: My wish for how I want people to treat me.

Wish 5: My wish for what I want my loved ones to know.

The form guides your parent through the decisions that have to be made in each of these areas. When she is done I suggest that you give her the opportunity to go through the form with you and discuss each area. You will be very glad that you did.