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Mini-CHAMP Part I: Hospice and Palliative Care--the Idea & the Medicare Benefit Part II: Teaching how to “Break Bad News”. Seema S. Limaye, MD University of Chicago. Part I : Hospice and Palliative Care--the Idea & the Medicare Benefit. Part II : Teaching how to “Break Bad News”.
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Seema S. Limaye, MD
University of Chicago
Section of Geriatrics
September 8, 2008
Mini-CHAMP Lecture Series
focus is on pain and symptoms management
patient has a terminal diagnosis with life expectancy of less than six months
not seeking curative treatment
focus is on pain and symptom management
patient does not have to be terminal
may still be seeking aggressive treatmentComparing Hospice vs. Palliative Care
4. I need to be “DNR” to sign-up for hospice.
5. I lose control/access to medical care if I sign-up for hospice.
6. I cannot dis-enroll from hospice if I change my mind or get better.
7. It’s “too early” for me to sign-up for hospice.
-If patient is medically appropriate for hospice, focus on the extra support they will receive at home, and improved quality of life because of symptom control.
Design: Randomized, blinded controlled trial.
Follow-up period: Death or end of study period.
Setting: 2 HMOs in Hawaii and Colorado, USA.
Patients: 310 patients (mean age 74 y, 51% men) who had a primary diagnosis of congestive heart failure, chronic obstructive pulmonary disease, or cancer; had a life expectancy < 12 months; had visited the emergency department or hospital within the previous year; and scored 70% on the Palliative Performance Scale.
Brumley R. et al.Increased Satisfaction with care and lowered costs: results of a randomized trial of in-home palliative care. JAGS; 2007;55;993-1000.
Disease modifying medical therapy
*Curative, life-prolonging, or palliative in intent
*Symptom control, supportive care
Baile WF. Buckman R. Lenzi R. Glober G. Beale EA. Kudelka AP. SPIKES-A Six Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist 2000;5;302-311.