Physicians confused by terminal illness
Physicians confused by terminal illness
Physicians agree that pain control, patient and family comfort, and quality of life are the most important aspects of palliative care and could reduce costs while improving quality and continuity of care. They expressed concern, however, that under managed care, expensive medications that could help bring about the desired improvements may not be allowed.
These attitudes were garnered from small focus groups of community hospital physicians where end-of-life issues and palliative care were the topic of discussion.1 Palliative care, which is offered to patients whose disease is no longer responsive to curative treatment, has as its goal to improve their quality of life, including helping patients control pain and providing psychological, social, and spiritual support for them and their families. Because physicians are the most involved of health professionals in palliative care, researchers believed their viewpoints on how it can be made more effective are especially important.
Researchers conducted four focus groups of 23 physicians (generalists and specialists) at a community hospital. A professional facilitator used a written guide to cover major issues of palliative care, including current providers’ behaviors, perceived needs, and suggestions for improvement in providing palliative care. The transcripts of the proceedings were analyzed to determine primary themes and then were coded and analyzed for patterns and variations in beliefs. Among their findings were:
• Physicians agreed that informing patients of their terminal illness is the first step toward implementing palliative care. But physicians expressed confusion on the legal definition of terminally ill, and they differed in their opinions on which type of physician (hospital-based specialist or office-based generalist) was best suited to inform the patient; what style of communication (direct and blunt or overly optimistic) was best; and how much to involve family members.
• The physicians saw benefits to having a specialized palliative care unit or designated team that would coordinate hospital and home care, with a focus on keeping the patient at home as much as possible with complete pain control.
• Many of the physicians expressed discomfort dealing with the legal and ethical issues of terminally ill patients, including advance directives.
"Physicians perceived legal issues in palliative care as having many ambiguities and gray areas," the researchers wrote. "Lack of clear guidelines on palliative care can expose both patients and physicians to unnecessary pain and suffering."
Reference
1. Alaeddini J, Julliard K, Shah A, et al. Physician attitudes toward palliative care at a community teaching hospital. The Hospice Journal 2000; 15:67-86.
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