"At least one in four Americans dies in a nursing home, and considerable evidence indicates that nursing home residents do not receive optimal end-of-life care," background information in the article states. Approximately 25 percent of residents with daily cancer pain receive no pain medications, and residents are often transferred to an acute care setting to receive aggressive treatment in the last weeks of life. Families often express dissatisfaction with the end-of-life care their relative receives in nursing homes. Nursing home residents receiving hospice care are more likely to receive better pain management, have their pain assessed and have lower rates of inappropriate medications and physical restraint use. Despite its benefits, however, only one in four nursing home residents enrolls in hospice care before death.
David Casarett, M.D., M.A., from the Philadelphia Veterans Affairs Medical Center, Philadelphia, and colleagues conducted a randomized trial of nursing home residents and their decision makers to determine whether promoting communication about hospice would increase hospice enrollment and improve the quality of end-of-life treatment. For the intervention, the researchers interviewed residents and/or their surrogate decision-makers to identify those whose goals and needs for care, and treatment preferences made them appropriate for hospice. The physicians of residents classified as appropriate for hospice were notified and asked to authorize a hospice informational visit. The trial was conducted from December 2003 to December 2004. Residents were followed up for six months or until death.
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