tag:blogger.com,1999:blog-3537910058667804944.post4911938165616575519..comments2024-03-28T03:19:24.894-04:00Comments on Costs of Care: Caveats to “letting go”Sam Lorenhttp://www.blogger.com/profile/00278404325077711750noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-3537910058667804944.post-75081711029688553832011-04-07T21:19:44.268-04:002011-04-07T21:19:44.268-04:00However, many family members that care for their l...However, many family members that care for their loved one on <a href="http://www.hospice-care-network.org/" rel="nofollow"><b>hospice services</b></a> view their efforts as one gift to their loved one. Thanks for sharing.Sandrahttps://www.blogger.com/profile/02376935840848967267noreply@blogger.comtag:blogger.com,1999:blog-3537910058667804944.post-25484183622991087342010-09-13T21:31:04.198-04:002010-09-13T21:31:04.198-04:00Hi Heather:
You bring up a good point. I recalle...Hi Heather:<br /><br />You bring up a good point. I recalled reading a study years ago showing that ICU nurses were unable to predict patient perceptions of quality of life after discharge. Patients rated living as a good thing, while the nurses estimated that life was lousy. If anyone is familiar with some data on this, please share.<br /><br />Jaan aka the DMCBJaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-3537910058667804944.post-24070960794966031252010-08-27T07:50:08.170-04:002010-08-27T07:50:08.170-04:00All fair points. Grappling with cost-effectiveness...All fair points. Grappling with cost-effectiveness at the end of life is extremely challenging. On one hand ICU care is very expensive and there is new data suggesting that for many patients it not only does not extend life, but as Heather points out may adversely effect quality of life. At the same time, families and healthcare professionals are unaccustomed to the idea of allowing death and our system is primed to spare no expense or resource.<br /><br />This is precisely why it is important for everyone to communicate their wishes for end of life early, and it is important that physicians begin these conversations with patients when they are healthy.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3537910058667804944.post-84619248589306237272010-08-27T01:52:10.911-04:002010-08-27T01:52:10.911-04:00Heather - Thanks for this. You do bring up a good ...Heather - Thanks for this. You do bring up a good point - which would require several years of a longitudinal research design to follow-up with patients. Having said that - it does raise questions about the appropriate use of ICU resources. <br /><br />I also agree with your second point - patients should be involved in such decision making. <br /><br />I suggest having a look at the DCMB blog here:<br />http://diseasemanagementcareblog.blogspot.com/2010/07/dr-gawande-hospice-new-yorker-and.htmlDivya Pamnanihttps://www.blogger.com/profile/09042596402866296310noreply@blogger.comtag:blogger.com,1999:blog-3537910058667804944.post-7518605467136539422010-08-27T00:08:39.463-04:002010-08-27T00:08:39.463-04:00The study you cite is only a study of if the peopl...The study you cite is only a study of if the people survive the ICU and live to hospital discharge. It says nothing about the patients' quality of life after surviving the ICU, or how long they survive after discharge.<br /><br />The question really should be how do we provide the best quality of care to patients at the end of life? I think the take away point of Gawande's article is that we should be encouraging patients to be making decisions about their end of life care, rather than avoiding making decisions. Certainly hospice needs more evidence, but so do all of the medical procedures we subject dying patients to.Heathernoreply@blogger.com