Volume 3, Number 2 Dear Colleague, Widespread discomfort over the subject of mortality became apparent in a recent National Hospice Foundation survey indicating more Americans are willing to discuss drug use and sexual activity with their children than end-of-life care with their parents. Although 80 percent of Americans reported they wanted to die at home, 83 percent said they knew nothing about hospice care and only 24 percent have put their wishes into writing. Advance directives are meant to protect each patient’s individual wishes. Given the capabilities of today’s medical technology, family members are too frequently forced to make major healthcare decisions for incapacitated patients. Only one-third of patients who are eligible, and in many cases covered by insurance or Medicare for services, actually utilize hospice to receive quality compassionate care that can enable them to die pain-free with dignity, often at home. Physicians, especially those who work in or are aware of hospice care, are charged ethically if not legally with giving patients the information they need to make one of life’s most important decisions. In this month’s VIA, we present summaries of journal articles about a new state law regarding medication dosages for patients with terminal illnesses, feedback on what African-American patients with cancer want their physicians to know about effective communication, an update on gender differences in the diagnosis and treatment of patients with heart disease and a journal editorial group’s perspective on the reporting of medical news. Please call us at (866) VISTACARE (847-8222) if you have questions or would like to speak with a hospice medical director or other hospice specialist in your community. Regards, Ronald J. Crossno, MD, FAAFP, FAAHPM N A T I O N A L  M E D I C A L  D I R E C T O R |  VistaCare

Ronald J. Crossno, MD, FAAFP, FAAHPM Table of Contents » Legislation Update: Second State Legalizes Physician-Assisted Suicide » Questionable Reporting: Sensationalized, Inaccurate Health News Misleads the Public » Effective Communication: Relationship-Centered Care Improves Quality of Life » Ailing Hearts: Gender Variation in the Management of Cardiovascular Disease Print-Friendly Version Email a Friend

The following is a summary of the article “Physician-Assisted Death — From Oregon to Washington State” by Robert Steinbrook, MD, that appeared in New England Journal of Medicine, December 11, 2008, 359; 24.

In this Perspective article, national correspondent for the New England Journal of Medicine Robert Steinbrook, MD, describes November 2008 election results in the state of Washington of special interest to physicians involved in hospice care. In March 2009, that state became the second to legalize a physician’s ability to authorize a prescription for a lethal dose of medication upon the request of a patient with a terminal illness. The Washington Death with Dignity Act, patterned after similar legislation passed in Oregon in 1997 and upheld by the U.S. Supreme Court in 2006, applies to adults with a life-expectancy of six months or less. A prior initiative Washington voters rejected in 1991 would have allowed physicians to administer the medication; this one stipulates that the lethal dosages must be self-administered. Dr. Steinbrook summarizes data from the Oregon Department of Human Services and provides a chart showing the number of patients who received such prescriptions as well as the number of assisted deaths over the same period. Of note is that 86 percent of the latter were enrolled in hospice programs. Demographic information on the patients is provided. The author lists improvements in palliative care associated with the passing of the Oregon law and also details concerns regarding lack of referral for psychiatric evaluation, screening for depression or proof of eligibility to receive the drug. Read more.

To view this article in its entirety, click here. To receive a free hospice eligibility kit, visit www.VistaCare.com/eligibility or contact your local VistaCare office at (866) VISTACARE (847-8222).

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The following is a summary of the article “False Hopes, Unwarranted Fears: The Trouble with Medical News Stories” by Public Library of Science Editors, featured in Public Library of Science (PLoS) Medicine, May 2008, Volume 5, Issue 5; e118.

This report describes a focus-group study conducted by North Carolina researchers who identified and explored culture-influenced issues affecting care for African-American patients with cancer. Motivated by statistics showing this demographic has the highest cancer-death rate of any racial and ethnic group in addition to low reported satisfaction with health care, the researchers expanded the procedures and scope of a larger study for this investigation. The 42 focus group participants had all experienced cancer or cared for a family member with cancer. An experienced African-American facilitator led the discussion utilizing the QUAL-E validated measures of quality of life. Findings indicated two consistent domains with component themes: 1) the need for effective communication with physicians characterized as reflecting a sense of the patient’s personhood and sharing messages tailored to suit the relationship; and 2) the need for a sense of control manifested by patient participation in decision-making that takes into consideration the needs of vulnerable populations, specifically older, poorer and less educated individuals. Read more.

To view this article in its entirety, click here. To receive a complimentary consult with one of our medical directors in your community, please call (866) VISTACARE (847-8222).

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The following is a summary of the article “Communication, Decision Making, and Cancer: What African Americans Want Physicians to Know” by Sharon W. Williams, Ph.D., Laura C. Hanson, MD, MPH, Carlton Boyd, MPH, Melissa Green, MPH, Moses Goldmon, Ed.D., Gratia Wright, BS, and Giselle Corbie-Smith, MD, M.Sc., featured in Vol. 11, No. 9, 2008, of the Journal of Palliative Medicine.

This report describes a focus-group study conducted by North Carolina researchers who identified and explored culture-influenced issues affecting care for African-American patients with cancer. Motivated by statistics showing this demographic has the highest cancer-death rate of any racial and ethnic group in addition to low reported satisfaction with health care, the researchers expanded the procedures and scope of a larger study for this investigation. The 42 focus group participants had all experienced cancer or cared for a family member with cancer. An experienced African-American facilitator led the discussion utilizing the QUAL-E validated measures of quality of life. Findings indicated two consistent domains with component themes: 1) the need for effective communication with physicians characterized as reflecting a sense of the patient’s personhood and sharing messages tailored to suit the relationship; and 2) the need for a sense of control manifested by patient participation in decision-making that takes into consideration the needs of vulnerable populations, specifically older, poorer and less educated individuals. Read more.

To view this article in its entirety, click here. To receive a complimentary consult with one of our medical directors in your community, please call (866) VISTACARE (847-8222).

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The following is a summary of the article “Ischemic heart disease and primary care: identifying gender-related differences. An observational study” by Inés Cruz, Catalina Serna, Jordi Real, Gisela Galindo, Eduardo Gascó and Leonardo Galván, featured in BMC Family Practice, 2008, 9:60 doi:10.1186/1471-2296-9-60.

Documentation of gender inequalities in the diagnosis and treatment of patients with ischemic heart disease (IHD) has emerged in recent years. This retrospective observational study utilizes clinical registry data for one city in Spain (Lleida), where medical records for 97 percent of the population have been entered into a comprehensive database since 2003. This study identified 1,907 individuals (1,266 men and 641 women) from a population base of 144,521 whose primary care records coded a diagnosis of IHD during 2006. Data analyses of this homogenous population (one that shares geographic location, urban setting and similar access to healthcare services) identified screening and management of cardiovascular risk factors and use of medications for secondary prevention along with demographic and diagnostic information. The findings quantify statistically significant gender inequalities in the management of IHD. Men of all ages were more likely to be prescribed medications for secondary IHD prevention, despite demonstrated benefits of such interventions for both genders. The authors urged primary care physicians to be alert to potential gender bias that could affect outcomes for women’s cardiovascular health. Read more.

To view this article in its entirety, click here. To schedule a free hospice education seminar in your office, contact your local VistaCare office at (866) VISTACARE (847-8222).

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