Understanding the importance of end-of-life care


By Hannah Drazenovich, Third Year Medical Student, University of North Dakota School of Medicine and Health Sciences

Modern medicine has many specialist teams that provide life-saving and life-saving care: cancer oncology teams, cardiac teams for heart problems, and neurology teams for dementia problems. Sometimes these teams are unable to cure a patient’s disease or condition. At other times, a patient decides not to continue the treatment offered by these teams. These are difficult decisions and patients do not need to make them on their own. This is where another team can be called in to help. Hospice is a team of healthcare providers who specialize in the management of symptoms when a curative treatment is no longer desired by the patient.

Palliative care focuses on comprehensive personal care, an approach that involves helping each patient determine their goals and priorities. When death seems near, the role of the palliative care team is to help patients achieve their goals in the remaining time. Goals can be anything, including staying home for as long as possible. While in palliative care, the patient may choose to focus on comfort and alleviate bothersome symptoms as much as possible, while treatments aimed at prolonging life are discontinued. Frequently treated symptoms include severe cough, difficulty breathing, uncontrolled diarrhea, nausea and especially pain. Other conditions that can be treated while enrolled in a hospice include worry, fear, depression, and sadness.

The hospice also helps prepare and guide a patient’s family and loved ones through the dying process, including the stages following the death of a loved one. Ongoing grief counseling support is offered to family and friends.

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The palliative care team is made up of doctors, nurses, social workers, chaplains and others, such as orderlies. These team members come to the house regularly and can be contacted 24 hours a day, 7 days a week, if needed. Medicines for symptom control and pain relief, medical equipment such as wheelchairs, dressings for chronic wounds, catheters and oxygen are brought to the patient’s home, saving family members to withdraw from work to locate, purchase and deliver these items. Medicare, Medicaid, and most private insurance plans cover these hospice services.

A myth about hospice care is that patients who sign up only have a few weeks to live. This idea often prevents patients and their families from asking their doctors about these services. In fact, patients get the most benefit from palliative care services when they start six months before medical providers think death seems most likely. In palliative care, the focus is on caring for the patient rather than on the patient needing care. Care is provided wherever the patient’s “home” is located, such as the patient’s private residence, nursing home or assisted living facility.

Another myth about hospice care is that once a patient registers, he or she cannot sign. The provision of palliative care is flexible. There are cases when a patient’s terminal illness improves or someone decides to seek a cure. If this happens, patients can still choose to opt out of hospice care and can re-enroll at any later time if they wish. Again, the goal of the hospice is to ensure that the patient’s wishes are met and that the wishes change from time to time.

Of course, the time of death is always unpredictable. For this reason, the discussion around death seems more natural to avoid than to attempt a discussion at all. But with the presence of certain medical conditions – cancer, dementia, heart disease, and stroke – death is more predictable. Learning about palliative care focused on comfort, dignity and comprehensive patient care can make a difference for patients and their families.

Hannah Drazenovich was selected as a Jamestown participant for the school’s Rural Opportunities in Medical Education (ROME) program. The program includes teaching medical students the importance of rural newspapers. As a future rural health system leader, Drazenovich wrote this column to provide health information to his ROME community. The information is not intended for diagnosis or treatment and should not be used in place of prior medical advice provided by a licensed practitioner.


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