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Marian Grant

I am a former marketing executive who's now a Nurse Practitioner for an in-patient palliative care consult service. My dream is to develop a consistent message we can use with the public to start getting people to request our services. I'd be happy to discuss further with whoever else is interested!

Sharon Weaver, RN

Dr Hallenbeck,
I echo your sentiments exactly. How wonderful it would be to see pts come into hospice with pain and other unpleasant symptoms having been relieved throughout their treatment. Too often, they seek hospice care in desperation for relief.

Sandra Crofton, RN

I have read your article, and do not understand why the Act of Congress to put through pain management for people. This is already included in Hospice regulations. Why did they rewrite all this new legislation when educational incentives could have just been added to the Hospice existing bills? I guess, in a round about way, I am asking what is the differences between Hospice and Palliative care. And the answer is NOT that Palliative Care provides curative treatment, as one person told me. This is only to be done when it is to relieve pain, and we already do this within the boundaries of Hospice. Also, narcs/controlled substances are used in large doses for pain, so this is not new. I agree, there are doctors who at times limit the amounts of pain RX to patients, when they could benefit from more, but then this falls again into education that would be as much pertinent under Hospice as it is a new classification called Palliative care. HELP?????

John McPhail

I think the reason it may seem at times as an "act of congress" to offer palliative care as a staple treatment for the terminally ill, lies with our culture mindset. The United State's Culture doesn't know how to die and so anything but curative measures is seen as giving up. We are not a "give up" culture. But, as Dr. Hallenbeck points out, is the fact that most people (unknowingly perhaps) want palliative care as they become aware of the changes within their own body. Its odd to me that the person with a life limiting illness is thrown out into a fast moving stream and expected to swim, while others dictate their choices for care. The terminally ill feel "shame" or "guilt" for making their real feelings known, after all - nobody is asking them for their input, and nobody seems "brave enough" to ask the terminally ill how they want to live.



"We’re a long way from this ideal." Indeed, we are, as palliative medicine in this country ermains at best two parts accomplishment for three parts potential. So long as the so-called "culture war" rages on in the US, and permeates the debate about how to reform the US health care system, end-of-life care, and by extension palliative care, will be relegated to vituperative pronouncements by ideologues quick to weigh in with their own beliefs about what constitutes "appropriate" end-of-life care. The Schiavo case was high-profile to be sure, but unfortunately, not an isolated one.
Why should we expect the public to understand palliative medicine when medical education professionals are split in their views of end-of-life care? A 2002 national survey of Medical Education Deans about end-of-life care in the curriculum revealed that a majority of the deans opposed required courses or clerkships that focused on end-of-life care.

Hospice Care

Both teams provide care that focuses on patient comfort. However, hospice care is generally suggested by a physician after all options for treatment have been tried and found to not be useful.

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