New feature tracks the birth of a new industry
Two years ago, an article in Journal of the American Medical Association,1 presenting the main findings from SUPPORT (Study to Understand Prognoses and Preferences from Opportunities and Risks of Treatments) finally forced conventional health care providers, the news media, and the public to acknowledge the serious, intractable shortcomings in medical care for Americans approaching the end of life. Phase one of this massive $28 million study exhaustively documented the problems, while the failure of expert-designed phase two interventions to effect any improvement in patient-doctor communication or other targeted outcomes underscored just how deep and systemic these problems really are.
In the last two years, SUPPORT researchers have published additional articles elaborating on the results. Philanthropic groups such as the Robert Wood Johnson Foundation and the Project on Death in America have poured millions of dollars into the search for solutions, while mainstream medical institutions such as the American Medical Association and the Institute of Medicine have launched new educational initiatives or issued lengthy reports. And palliative care units, programs, or consulting teams have attempted to bring hospice concepts of terminal symptom management into acute care hospitals coast to coast. (See Hospice Management Advisor, November 1997, pp. 121-126.)
Are we witnessing the birth of a new medical industry targeting the care of patients nearing the end of their lives? And where does the existing $2 billion hospice movement, currently caring for 450,000 dying Americans per year, fit into this nascent trend? Some say hospice, as the only proven experienced, large-scale provider of end-of-life care, needs to be leading the parade. Others say hospice needs to change if it is to meet new, emerging, and currently unmet needs for the four-fifths of dying Americans who don’t benefit from hospice care. Otherwise new end-of-life programs and models will arise to fill these needs, perhaps supplanting or marginalizing hospice’s role in care of the dying.
Each month, this column will highlight some of the leading trends and developments in the larger end-of-life field and present evidence of the new industry’s coalescing in light of its tremendous relevance for the future of America’s hospices.
Reference
1. Support Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. JAMA 1995; 274:1,591-1,597.
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