Hospice to help hospitals provide palliative care
Asking for help is hard for doctors, hospitals
(Editor’s note: As more ethics professionals become involved in collaborative efforts to change care of the dying, we offer an insight into how these efforts among providers in different settings and, perhaps, with different mindsets and goals, are going. The following article examines a collaborative effort among a hospice, hospital, and physician group for more than one year.)
Hospice professionals are learning that to help other health care professionals understand and appreciate the philosophy of palliative care, they have to "almost give it away." It will take a paradigm shift before many physicians and hospital administrators are willing to view "low-tech comfort and compassion" with the same reverence as "high-tech billable procedures," says Bernice Wilson, president of the Ohio Hospice Organization in Columbus.
Following a legislative mandate in 1996 to come up with education for all Ohio physicians on pain management, Wilson has guided a collaborative effort among the state’s hospices, hospitals, and doctors to accomplish this educational goal. The hope was to have a demonstration project of three professional groups working together to offer education and measure its effectiveness.
The process has moved slowly, however, and taught Wilson that change will be incremental and gradual. The experience provides lessons for other hospice professionals and ethics committee members who are interested in creating partnership efforts, she says.
The Ohio State Medical Society and the Ohio State Hospital Association, both in Columbus, have joined in meetings with the hospice organization over the last year to develop education for physicians on pain management. The medical society plans to develop continuing medical education materials on pain management for all state physicians by the end of the year, says Carol Mullinax, director of public affairs, who is in charge of the project for the professional medical group.
Two continuing medical education credits will be issued by the Ohio State Medical Society to physicians who choose to participate.
"Physicians have expressed concern about the increased scrutiny when giving medication for the treatment of chronic pain," says Mullinax. "This is not as big a problem in treating terminally ill patients."
However, she says, "Some physicians may not be aware of the latest treatments for pain that might help the terminally ill. The point of our program will be education for the state’s physicians about the need for better pain control in all circumstances," she says.
Getting doctors and hospitals to take an honest look at how the provide end-of-life care is difficult, Wilson says. "Many physicians believe that they are already doing a good job, despite the research that says otherwise. If you ask them about their hospital and their patients, you get a different assessment," she says.
The collaborative effort among Wilson’s group and the other professional societies must be viewed as positive because it is a first step, she says. "The reason we started our collaborative work with an issue like pain control is that it is measurable. We thought, Who can be against pain control?’"
How to create change
Hospice and ethics professionals must continue to advocate for changing the course of dying in all health care settings, Wilson says, adding that they also must do the following:
• Practice humility. "You can’t get frustrated when people don’t see it your way."
• Give it away. "Hospice professionals can’t wait for others to ask for our knowledge of comfort care. We have to give it away."
• Meet on their’ turf. "Go to your state medical boards and even doctors’ offices. Talk to them where they work."
• Be patient. "This is a long-term training program. Changes in end-of-life care will not come overnight, but we must keep trying."
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