RSS Feeds
Care at the End of Life
- Wendy L. Adams, MD, MPH; and
- Catherine Eberle, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
The excellent review by Hanson and colleagues [1] reveals a striking omission in interventions designed to change care at the end of life. All the studies cited aimed to increase communication about the patient's preferences for care or to reduce the use of certain types of interventions. None apparently offered the patients or their caregivers meaningful and realistic alternatives to usual hospital care.
Terminal illness often brings with it disability; pain; and the need for assistance with eating, bathing, dressing, and toileting. In our society, the options for meeting these needs are very limited. Hospice care is not available in all communities; in areas where it is available, most is provided as home care. The hours of reimbursable professional services are limited; thus, unless relatives or friends can provide considerable personal care, hospice care at home is often not an option. Nursing homes are sometimes used for terminal care. However, very little care in nursing homes is reimbursible by third-party payers, and nursing home personnel are not usually well trained to provide good management of pain or dyspnea. Counselling for the emotional issues of the dying is rarely provided in this setting. Because of these limitations, patients whose terminal illness becomes too painful, frightening, or messy to be dealt with easily at home often come to acute hospitals for terminal care. When a patient is admitted to the hospital, there is immediate pressure, because of reimbursement policies, to discharge the patient quickly if aggressive interventional care is not provided.
Even if a patient chooses to have “comfort care only” at the end of life and expresses his or her wishes clearly to a physician, our health care system puts up substantial barriers to receiving such care. Until we can offer more practical resources for palliative care, we are unlikely to change how patients or their physicians behave at the end of life.
Wendy L. Adams, MD, MPH
Catherine Eberle, MD
University of Nebraska Medical Center; Omaha, NE 68198-5620
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
