FAQs

It's All About the Conversation - FAQs

Does hospice care hasten a person's death?
No. Hospice is committed to neither hastening nor prolonging death. Its goal is to expand the universe of the dying patient while the disease seems to contract it. Reimbursement for hospice care usually does not cover curative treatment, but it can and does cover interventions that control distressing symptoms, with the goal of improving the patient?s quality of life. There is research that indicates that excellent supportive care can lengthen life in persons who are terminally ill (Temel et al., 2010). See the Community Resources and Clinician Education pages for links to hospice and palliative care information.

Does the new health care law include provisions for "death panels"?
No. In its original form the law contained a provision that would have reimbursed physicians for taking the time to ask their patients what level of treatment they would prefer to receive if they were terminally ill, since they may be too sick to communicate clearly under those conditions.  This provision became confused with a notion of ?death panels,? famously articulated by Sarah Palin in the summer of 2009.  The provision was removed from the proposed legislation before it became law, making such conversations less available to physicians and patients alike.

What is a "POLST" form, and how do I get one in Nebraska, since they are not yet widely used?
"POLST" stands for Physicians' Orders for Life Sustaining Treatment.  The form is usually printed on heavy stock in a vivid color, so that it is easy to find in a patient's records.  The form is a physician's order, and it results from a conversation between a patient who may be elderly and/or chronically ill, and a physician.  The information contained in the form includes the patient's preferences regarding a variety of treatments such as cardiopulmonary resuscitation, tube feeding, blood transfusions, and admission to the hospital. More information about the form is available at www.polst.org. In Nebraska, the form is being used in Columbus, Kearney, and Grand Island. Copies of the form may be obtained by contacting helenchapple@creighton.edu.

On TV shows, people who are resuscitated often survive. How well does Cardiopulmonary resuscitation (CPR) work in real life?
The media tends to exaggerate the effectiveness of CPR. While research to improve the outcomes continues, CPR's record of success is surprisingly poor, especially when it is compared to many other common medical interventions. Numbers vary depending on the health of the victim prior to collapse, the location of the victim, the speed of response, and the skill of the rescuers. CPR on TV often averages a 40% success rate (Jones, Brewer, & Garrison, 2000). The success of CPR in real life varies from 1% to 18%(Garza et al., 2009; Codagan, 2010)

What is the difference between an Advance Directive and a Do Not Resuscitate order?

Many people, including clinicians, can get these terms confused. It's important to understand the differences between them and the purposes they serve.

An advance directive can be completed by anyone over 18 (or 19 in Nebraska). Think of it as a sort of wish list for the future, because it has no connection with your current state of health. It can include the treatments you would prefer or dislike under conditions when you are unable to speak for yourself. These conditions may prevail when you are permanently unconscious or terminally ill. It can specify the person (called surrogate or proxy) you would like to be managing your health care decisions at that time. It can also document your desire to donate your organs, or to decline to donate. It is meant to be a tool of communication to others about your wishes only when you are unable to state those wishes on your own, and you are unlikely to regain that ability.

A Do Not Resuscitate order (DNR) is a physician's order that refers to one treatment only: cardiopulmonary resuscitation (CPR). CPR includes chest compressions, shocking the heart, and inserting a tube in the trachea to open the airway. It can cause major damage to the ribs, and its success rate is far less than on TV. Your physician could issue a DNR order after consulting with you and/or your surrogate when it was clear that resuscitation would not be of benefit to you, such as in the advanced stages of a terminal illness.

References


Codagan, M. P. (2010). CPR decision-making and older adults. Journal of Gerontological Nursing, 36(12), 10-15.

Garza, A. G., Gratton, M. C., Salomone, J. A., Lindholm, D., McElroy, J., & Archer, R. (2009). Improved patient survival using a modified resuscitation protocol for out-of-hospital cardiac arrest. Circulation, 119(19), 2597-2605.

Jones, G. K., Brewer, K. L., & Garrison, H. G. (2000). Public expectations of survival following cardiopulmonary resuscitation. Academic Emergency Medicine, 7(1), 48-53.

Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., . . . Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363, 733-742.