“Family Dynamics And Doctors’ Emotions Drive Useless End-Of-Life Care”

  • Rutgers and researchers of other university developed a behavioral model “that explains a long-standing healthcare mystery: Why do so many terminally ill patients undergo intense last-ditch treatments with little chance of meaningful life extension?” Most people want to die at home, as numerous surveys have shown, but painful and “long-shot” treatments are common.
  • Most analyses, says an article shared by newswise, up until now have focused on patient feedback on their preferences in end-of-life. This new model, called the Transtheoretical  Model of Irrational Biomedical Exuberance (TRIBE) “focuses squarely on clinician psychology and family dynamics.” In the past, we have acted as if clinician’s care decisions are logical. When physicians recommend treatments and procedures, “there’s enormous pressure on patients to undergo it.” The TRIBE model “shows how emotional pressures on doctors and complex family dynamics provoke excessive efforts to cure incurable conditions.”
  • The TRIBE model addresses the reality that clinicians are emotional beings…. “and these emotions strongly impact their patients’ choices.” Physicians don’t want to let go. The researchers call for improved medical education “and the culture of irrational biomedical exuberance.” Researchers say, in this article, that this impacts patients and doctors. “They read of one-in-a-million cures and  irrationally believe that their patients will be that one in a million…” Physicians fear that not offering these long-shot treatments “is tantamount to abandoning loved ones.”
  • The authors of the article, from Tulane, Rochester and Rowan, call for a change in the “culture of medical education and broader cultural attitudes toward death…” Needed change will address “family dynamics that have prevented too many patients from receiving quality care in their final days and weeks of life,” say the researchers. (newswise, 1/17)

 

HOSPICE NOTES

Husch Blackwell offers a new podcast in the Hospice Audit Series: “Welcome to the Party: Contractor Participation at ALJ Hearing.” Though audits have been reduced during COVID, there are “hints at increased activity as the pandemic wanes.” The Hospice Audit team reviews “the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and, most importantly, what hospices can do about it. The podcast is online at the link below. (Husch Blackwell, 1/18)

 

PALLIATIVE CARE NOTES

An article in Journal of Pain and Symptom Management reports on the work of a research team to develop and test “patient-reported measures” in palliative care domains. The measurements created received National Quality Forum endorsement. An abstract of the article is available at the link below. (JPSM, 2/1)

 

END-OF-LIFE NOTES

Advocates both for and against medical aid in dying gathered in Hartford, CT, to share their support or opposition to the practice. A proposed bill, that will be debated by the general assembly, would legalize the practice. (NBC CT,1/18)

Ellen Gilland went to a Daytona, Florida, hospital and shot and killed her husband who was terminally ill husband. Her husband, Jerry, and she had made a pact for a murder suicide if his health did not improve in a few weeks. Police had to use a flash bang to distract her because she would not put the gun down. She has been arrested and charged with first degree murder. Tony Ray, founder and president of Florida Death with Dignity, plans to bring a bill allowing medical assistance in dying, the Florida End-of-Life Options Act, to this year’s Florida legislative session. The first link below leads to the video story and transcript. The second link leads to a news story of Tony Ray describing his organization’s plans.(NBC’s WESH 2 News, https://www.wesh.com/article/daytona-beach-woman-kills-husband-hospital/42611803;  WESH 2 News)

 

GRIEF AND ADVANCE CARE PLANNING NOTES

An article in MindsiteNews explores the growing demand for grief therapists and how easy it is to get a certificate. Investigative reporter Astrid Landon tells how she signed in online to earn a “certificate of successful completion from a continuing education provider.” She pressed the start button to begin a six-hour recorded course. As this ran the program on her computer, she reports, she caught up with friends, baked, and binged a Netflix show. Then she went back to the computer and passed the test and downloaded her certificate. It was, she said, “ridiculously easy: The answers to the final quiz are summarized on the handouts shared prior to the test.” She tells of a number of other programs that also offer such products. For one of them, she says she signed into the computer and bought the course “at 1:37 am and received my certificate of completion at 1:39 am.” The article examines the reasons “grief counseling has boomed,” and the lack of governance over who can serve as a grief counselor. She tells of a 14-year-old and a cat being certified grief counselors. The article also examines the difficulty of finding “gatekeepers.” A professor at the University of Memphis, quoted in the article says, “You can go through the entire graduate curriculum in psychology and social work, even, astonishingly, in chaplaincy or palliative care and nursing, and never hear the word grief.” Readers are warned to ask grief counselors about their educational backgrounds and training. (MindsiteNews, 1/4)

~ JAMA Oncology includes an article that reports on research of serious illness conversations (SICs) “between oncology clinicians and patients associated with improved quality of life and may reduce aggressive end-of-life care.” Few cancer patients have an SIC. Using “machine learning-triggered reminders,” physicians were urged to engage dying patients in SICs. During the research period, advance care planning rates “nearly quadrupled among high-risk patients, rising from 3.4 percent to 13.5 percent.” Potential harmful therapies decreased by 25 percent, and chemotherapy for patients who died during the study, decreased from 10.4 to 7.5 percent. (JAMA Oncology, 1/12; HealthAnalytics, 1/19)

 

 

 

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Hospice Analytics is the national sponsor of Hospice News Network for 2022. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com