Sunday, November 4, 2007

This presentation is part of : End-of-Life Strategies
Bridging the Gap: Facilitating Palliative Care at the End of Life in a Community Based Hospital Setting
Michele S. Loos, BS, RN, MS, Department of Palliative Medicine, Wentworth-Douglass Hospital, Dover, NH, USA
Learning Objective #1: identify three barriers to providing optimal end-of-life care in the community hospital setting.
Learning Objective #2: describe three strategies to facilitate the creation of a multidisciplinary palliative care consultation service

As life expectancy increases due to improved medical technologies and health education, death from acute diseases is overshadowed by ever increasing numbers of individuals succumbing to chronic diseases later in life.  Despite increased attention from various accredited clinical, professional and academic entities, the attainment of a “good death” remains elusive for large numbers of individuals. For many patients, pain and suffering at the end-of-life is extreme. While progress is being made, research indicates that many dying patients do not experience a death congruent with their stated wishes.  In the United States, large percentages of terminal patients in hospitals continue to meet the end of their lives suffering from a myriad of distressing symptoms, while often still receiving invasive and aggressive treatment.  Indeed, nurses often lament the “futile care” provided at the end-of-life, seemingly at the expense of appropriate attention to distressing symptoms, e.g. pain, dyspnea, spiritual and/or emotional distress.  

Palliative care, focusing on pain control, emotional and spiritual well-being, and the management of other complex symptoms, emerges as the choice of care for many who wish to retain control over the method and means of treatment at the end-of-life. 

Community hospitals can face particular challenges in delivering optimal end-of-life care. These can include having limited resources (both human and financial), having fewer available experts, or difficulty in implementing new programs. This paper describes the process with which one community hospital is improving care for chronically ill and terminal patients through the implementation of a palliative care consultation team. The steps involved in convening a multidisciplinary task force, conducting a comprehensive needs assessment, setting goals, identifying and meeting the educational needs of staff and administrators, and navigating myriad administrative hurdles will be addressed, as well as recommended strategies that can be used to replicate the process in other facilities.