One strategy to decrease overtreatment…

A hundred years ago we did not need to worry about this… but when dying in the 21st century, overtreatment is possible, can add to disease burden, can decrease quality of life, and is in fact a concern that we need to address!

Article in NY Times by Tara Parker Pope, “Overtreatment is taking its toll”  “When it comes to medical care, many patients and doctors believe more is better. But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system … and taking a human toll in pain, emotional suffering, severe complications and even death.”

In her book “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” Shannon Brownlee points out that more health care does not necessarily make one healthier, that some tests and procedures can actually do harm.

Research indicates that when substitute decision makers do not know a person is dying, they will err on the side of further acute agressive treatments, rather than on comfort care.  Education is key to making informed choices.

One simple step to help decrease the burden of overtreatment is simply to provide individuals with adequate information in a way they can understand and comprehend the content, and then to support the patient/family to make informed decisions.

The Canadian Hospice Palliative Care Association (CHPCA) in the Model to Guide Hospice Palliative Care outlined the Process of Providing Care:

ASSESSMENT, followed by INFORMATION SHARING, then support to help patient and family with DECISION MAKING will help patient and family develop individualized, appropriate CARE PLANS, IMPLEMENTATION OF CARE and then CONFIRMATION or evaluation to see if the needs are being met.

It is possible that even with good information some people will chose many tests and procedures.  But at least they will do so with information and while being supported in their decision making.

It is totally inappropriate to investigate, intervene, implement, push, prod, pull or puncture…  without providing relevant information including the benefits and burdens.

For ideas on information sharing… stay tuned!



Physician Assisted Suicide – CHPCA issues paper

I am including the link to the Canadian Hospice Palliative Care paper that summarizes the issues and discussion for and against PAS.

It is meant to inform and encourage discussion of this topic among hospice palliative care providers, as well as the public. It offers a foundation of facts from which its members and others may draw upon when discussing the issue of euthanasia and assisted dying.

Physician Assisted Suicide – CHPCA statement

THe recent decision by the BC courts to strike down the ban on PAS has brought the topic to the forefront again.

The last time I wrote about Physician Assisted Suicide (PAS) I was a student and the paper was thirty pages long.  (Bless the prof who had to read it!)

The Canadian Hospice Palliative Care Association provides an excellent statement on their position, which is well worth the read! I have included it here, and the link to the website. In future posts I will discuss this from a more personal perspective, and will identify key issues that might be of interest to students.

Canadian Hospice Palliative Care Association (CHPCA) clarifies it’s position on the subject:

“Whether you agree with euthanasia and assisted suicide or are entirely against it, there are some key messages and things that we know regardless of opinion.

Key Messages:

The recent preoccupation with euthanasia and assisted suicide is taking time away from the issue of access to hospice palliative and end-of-life care for all Canadians.

That euthanasia and assisted suicide is not and never will be a part of hospice palliative care.

The Norms of Practice (2002) define hospice palliative care as care that aims to relieve suffering and improve the quality of living and dying.

Hospice palliative care providers have observed – and these observations are confirmed by research evidence – that the desire for euthanasia or physician-assisted suicide usually stems from one or more of the following factors:

  • a desire not to be a burden on others;
  • the individual’s need for control over the illness and his or her body/life;
  • depression and psychological distress often associated with illness;
  • the pain and suffering caused by all terminal illnesses.

Comprehensive hospice palliative care can help alleviate many of the factors that may cause people to consider physician-assisted suicide, particularly the burden on loved ones, depression and pain and symptom management.

Canadians are confused between euthanasia; assisted suicide; do not resuscitate; sedation; the right to refuse treatment; the right to refuse hydration; the right to refuse nutrition and many other terms and instead appear to lump them all together.

In the hospice palliative care experience, the process of dying has meaning and purport for the person as well as his or her loved ones. As a field of practice, we have the responsibility to ensure that all those involved in providing hospices palliative care have the knowledge (including an understanding of the alternatives to physician-assisted suicide), attitude and skills to help people at end-of-life manage both physical and emotional suffering, and to support family members. We also have a responsibility to ensure that patients seeking physician-assisted suicide are aware of other options.

Highlighting Canadian Virtual Hospice

October 20th

I am in Winnipeg attending the CHPCA conference. It is a treat to rub shoulders with such a wonderful group of individuals who are so passionate about providing excellent care for the dying.

Our booth for Life and Death Matters is located next to Canadian Virtual Hospice (CVH). This is one of “Canada’s gems!”  CVH provides resources for patients, family caregivers and professionals. Their website is rich with information, previously asked questions and answers, and links to relevant sites. Perhaps most important, they are available to respond to questions – and usually respond within 24-48 hours!

The team includes Clinical Nurse Specialists, Brenda, Lisa and Simone (wonderful women!), the physician Mike Harlos (a gem of a man!), and the social worker Fred Nelson (I think he works nights as a comedian). They divide their time between clinical work and providing support online.

They respond to questions using language that is easy to understand with answers that are grounded in best practice.

CVH has pamphlets, book marks, and trinkets to advertise their service. I love to hand these out during workshops, but think they would also be a useful handout to make available on hospice units, hospital wards, etc..

Be sure to check out the CVH website, mark it as a favorite and pass it along!