When Catherine M. Mullahy, RN, BSN, CCRN, CCM, presents educational seminars to case managers, she always asks how many people in the audience have advance directives. Typically about 5% to 10% raise their hands, she reports, adding that the usual reason people do not is, “It’s not time yet. I’m too young.”
“The biggest barrier to having end-of-life discussions is not necessarily the patient’s reluctance to talk about the issue, but healthcare professionals who are concerned about their own mortality and are unwilling to discuss it,” adds Mullahy, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.
There is a stigma attached to hospice, Mullahy points out.
“We live in a youth-obsessed culture that does not value old people. Everybody wants to be young and most people, even healthcare professionals, are reluctant to accept that they are going to die,” Mullahy says.
Case managers have to be comfortable with end-of-life issues before they can have a meaningful conversation with patients and families, adds Patrice Sminkey, RN, chief executive officer for the Commission for Case Manager Certification.
“When you are uncomfortable about a topic, it may be hard to bring it up. Clinicians aren’t uncomfortable talking about hygiene, and they shouldn’t be uncomfortable talking about end-of-life care,” Sminkey says.
When people think of hospice, often the image of dark rooms with patients moaning come to mind, Mullahy says. “Hospice isn’t like that. We have medication, relaxation techniques, massage, and so many other modalities that make the patient comfortable,” she says.
Before case managers have the conversation about end of life with patients, they should start by discussing the subject with their own families, Mullahy says. “How can we expect to advocate for patients if we are afraid of the experience and have not yet thought about our own end-of-life issues?” she says.
Case managers need to educate themselves about advance directives and end-of-life issues, Sminkey says. Share the information with your loved ones and make your own wishes known, she adds.
Participate in education and training about end-of-life care. Become familiar with hospice services, what they are, and what they aren’t. Otherwise, you won’t be able to accurately describe them to patients, she says.
“There are a lot of misconceptions about what hospice is and what it is not and what advance directives mean,” Mullahy says. Hospice care isn’t aggressive or curative, she said. It’s appropriate when providers have tried everything and the patient isn’t getting better. The goal of hospice is to keep people comfortable in their own home whenever possible, she adds.
Only a small percentage of case managers have had experience with patients at the end of life, Mullahy says. “Whatever knowledge nurses have is probably dated. Many nurses and physicians have been taught to be optimistic and to always look for another treatment possibility,” Mullahy says.
“If you don’t know what a piece of equipment looks like, you can’t include it in a discharge plan. At the same time, if you don’t know what hospice care is like, how can you discuss it with patients?” Mullahy asks.
She recommends that case managers make the time to visit a hospice facility in their area and meet with the staff. Talk to organizations that provide hospice services in the home to find out what they can do for patients. Invite someone from a hospice facility to a lunch and learn to educate other case managers.
Once case managers get a significant amount of knowledge about hospice and confront their own feelings, talking with patients and their families gets easier, Mullahy says. “One of the greatest roles a case manager can play occurs when a patient approaches death. End-of-life situations entail formidable need, emotion, understanding, and advocacy. Case managers are uniquely positioned to take a leading role in making this most difficult time more compassionate, peaceful, and dignified,” she adds.
Case managers have to be comfortable with end-of-life issues before they can have a meaningful conversation with patients and families.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content