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Clarifying the nature of hospice care

Published Apr. 20, 2012

Editor's note: Gary McCarragher is a hospice physician in Pasco County who believes more people would seek palliative care near the end of life if they better understood hospice. Last time, he reviewed the rights and privileges of the hospice patient. Today, he's discussing the hospice care plan. To see his earlier columns, go to tampabay.com/health.

MISCONCEPTION: When you're admitted to hospice, the only medications you receive are those needed to control pain. Your other medications are stopped.

TRUTH: Most of the medications that we use can be described as "comfort meds," those that control pain, anxiety, breathing difficulties, and other symptoms of distress. But hospice also supports patients who want to continue other drug therapies. For example, a lung cancer patient with a history of heart disease may wish to continue a blood thinner to reduce the risk of a sudden cardiac episode.

The risks and benefits of all medications are regularly re-evaluated as the patient's condition changes.

MISCONCEPTION: Hospice will not cover any aggressive, invasive or expensive treatments.

TRUTH: The goal of hospice is to maximize the quality of life for patients and their families. We seek the least intrusive and most cost effective way so that we can deliver this care to all those who desire it.

Most symptoms, such as pain, anxiety, or breathing difficulties, can be controlled well with medications alone, but hospice will provide whatever other treatments are needed to comfort a patient. For example, palliative radiation treatment may be considered for a cancer patient to control bone pain when pain medication alone isn't working.

MISCONCEPTION: Hospice doctors prescribe sedatives and narcotics that keep patients drowsy.

TRUTH: Meaningful interaction with family and friends can be crucial as death approaches. So we help our patients to be as alert as possible, while also relieving their symptoms. This can be challenging, especially for patients with severe or difficult to control pain, or for those who have altered mental status (as with Alzheimer's disease). But we can usually strike a balance that satisfies both patient and family.

MISCONCEPTION: Patients who receive hospice care die sooner than those with similar conditions who don't have hospice. Hospice is the "compassionate killer," using medications to hasten death.

TRUTH: The goal of hospice is to comfort without interfering with the time course of the natural dying process. Sedatives and narcotics can effectively control symptoms without hastening death. In fact, a study published in 2007 revealed that hospice patients with heart failure or cancer of the lung or pancreas lived an average of four weeks longer than similar patients without hospice. It's likely that good symptom control, emotional support and avoiding the severe side effects of some cancer treatments all play a role in this apparent survival benefit.

Adding hospice care to standard treatment may also improve survival. A study published by the New England Journal of Medicine in 2010 revealed that lung cancer patients who were given hospice care along with cancer treatment had a median survival of about 10 weeks longer than those who received cancer treatment, but no hospice care. This dual option, called concurrent care, is not covered by Medicare and Medicaid at this time, but is available in certain cases from some private insurance carriers.

Dr. Gary McCarragher received his medical training at McGill University and the University of Ottawa, and was a gastroenterologist in Brooksville for 18 years before going to work for Hospice and Palliative Physician Services, which contracts with HPH Hospice in Pasco, Hernando and Citrus counties. Follow him on Facebook and Twitter (drgarymac), or at garymccarragher.com.

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