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Docs receive guidance on end-of-life care
More than 1.4 million Americans were served by the nation's hospice providers last year, but patients, their families, and their physicians often don't know how to choose the best program for hospice, reports the National Hospice and Palliative Care Organization.
"While all hospice programs are very good, there are some programs that are really excellent," said Joan Teno, MD, a professor of community health and medicine at the Warren Alpert Medical School of Brown University and co-author of a recent article that addresses this issue.1 "You want to choose the hospice program that is striving and achieving excellence in quality of care," she added.
Authors Teno and Stephen Connor, PhD, consultant for research and international development at National Hospice and Palliative Care Organization, have identified the four key questions that a primary care physician faces in caring for the seriously ill patient with difficult symptom management:
Should I refer a patient to a hospital-based palliative care team or to hospice services for difficult symptom management?
If the patient is referred to a hospital-based palliative care team, what should I, as the primary care physician, expect?
When should I refer to hospice services a patient initially referred to a hospital-based palliative care team?
How can I choose a hospice program that will provide competent, coordinated, and compassionate patient- and family-centered care?
The article also describes guidelines for professionals, which are called the three Cs, to help determine whether the care being considered is "competent, compassionate, and coordinated." Guidelines for families are titled "the five Cs" and refer to the characteristics that families should look for when choosing a hospice or palliative care program:
competent care by interdisciplinary team;
care that is centered on the patient and family needs;
coordinated care and correct access to needed services;
committed to quality.
1. Teno JM, Connor SR. Referring a patient and family to high-quality palliative care at the close of life. JAMA 2009; 301:651-659.