Guarantee Your End-of-Life Wishes: Podcast 034

Palliative care, end-of-life, death with dignity are trending topic. They are of great interest to the aging population in America and to those who are or may become their caregivers. Over the past couple of years following my experience as a caregiver for my wife who was dx with stage IV cancer and following her passing I realized that there is a need that is largely unmet–EOL planning.


The majority of the 1.8 million Americans who die each year do not have their end-of-life (EOL) wishes or goals met. This failure extends the pain and suffering of the patient, their loved ones, and incurs a high financial cost that does not achieve quality or meaningful extension of life. The gap between what Americans want at end-of-life and what is delivered can be accomplished simply and efficiently.

Hospice The End and Beyond: Podcast 020

Hospice The End and Beyond…yes there is life after hospice. I talk about living after a loved one dies and the role hospice and the hospice team plays in this life altering event when we are left behind. The final week to ten days in hospice was pretty much a blur. A mass of shifting images that still choke me. During that time I was trying to keep myself busy. Again trying to will my way though this with activities around hospice and donna. I filled the day the night going to hospice to be with donna. And start again the next day. And the next. Ground hog day from hell.


Entering Hospice Dignity in the Face of Fear: Podcast 019

The overwhelming emotion when you first enter hospice is fear. Well not really fear just a blanket of sadness less about the place and more about how would this play out for how long and in what capacity. Perhaps though my eyes and reflection we identify a different emotion, one where we can find a safe place during this horrific sad time.


Home is Where the Heart Is. Dying at Home: Podcast 013

Carolyn and I discuss home hospice and in unit hospice. Carolyn shares what is involved with home hospice and how it differs from in unit care. I address my experiences first with home hospice and ending up on the unit. A very informative podcast that opened my eyes.


Delivering High Quality Cancer Care: Trend or Wishful Thinking?

A couple of days ago the Washington Post offered this “The best cancer care ins’t always the most expensive” written by Harold Pollack. The author takes a look at a recent report published by the Institute of Medicine (IMO) “Delivering high-quality cancer care: Charting a new course for a system in crisis.” His opening paragraph captures the report well…

Like many IOM publications, this report makes for depressing reading, not because it contains dramatic or frightening revelations, but because many of its recommendations are so obvious and yet would be so difficult to execute in our high-tech but unwieldy, costly and fragmented health-care delivery system.

Pollack summarizes the report well:

  • Too many patients having punishing and futile treatments
  • Costly imaging with little or no therapeutic benefit
  • Costly supportive care
  • Failure to use EHR
  • Fragmented care that drives miscommunication and errors

Cancer costs America 5% of the $2.8 billion healthcare economy and patients can benefit from more thoughtful and less toxic treatment when cure is not possible. Reading this I saw my film project “Care When There is No Cure“. And I thought of Donna and her care in the face of a Stage IV diagnosis for NSCLC. Donna was told she had 6 months. Her skilled and brilliant oncologist who I believe put care into healthcare told Donna when she asked him if she would die in 6 months “Not so fast”. He proceeded to create a course of therapy and care including a craniotomy that extended her life with excellent quality for nearly three years. I will say that the care Donna received looked like the chart below

I would take a look at the Washington Post article because there is an interview with Amy Berman who is a cancer patient diagnosed with Stage IV inflammatory breast cancer. She chose to receive palliative care three years ago. And her video is on the WP Web site as well as provided by the IMO. The video is excellent but, I must say the transcript from the discussion between Berman and Pollack is eye opening for its insight and candor. 

On the IOM Web site they have a complete list of items regarding this report from briefing slides, press release, questions patients ask, report brief, and videos. It is very complete resource for this important topic and issue. Did I say slide deck my fav format. The link to the deck is here.

The above slide is early in the deck but triggered my thoughts about communications, advertising, adult learning, and driving change. But the IOM speaks to the reality that  as a nation we will be facing this growing cancer crisis and not just in the prevalence of the disease but in the fact the crisis of how are we as HCP and caregivers are going to manage it and care for everyone. The fact is by 2022 30% of our aging population will have a cancer diagnosis. And consider the cost. By 2020 the cost of cancer care is anticipated to be $173 billion and increase of 39% from the $125 billion in 2010. And lest we consider just the toll on life there will be 18 million survivors of cancer by 2022. That number includes those less then a year to 15+ years. 

These are the report goals and clearly they will change the face of cancer care as we move forward. Each one is a task in and of itself with subsequent issues, problems, and outcomes. Following each of these goals are a listing of recommendations. I am struck not only by the reality of the list and recommendations but of the weight of each one to be started/implemented/accomplished either at the provider level or nationally. These are not small tasks nor are they all clinically driven.Which means can they be executed by the HCP alone or in a practice? Some of these are communications and educational. They are centered on the need to create programs, messages, tools, and more that is strategically driven and based on principles of education and marketing. Some of these are the soft arts not evidence based medicine or a p value. 

I question the ability of the medical and clinical community to drive the educational and communication goals they have laid out. Creating communications goals and aligned strategies are not easily achieved with measurable outcomes that meet and exceed the goals. What is needed are proven marketers who have shown success at driving HCP and patient change. In fact what is needed here are the very same people who convinced HCP to prescribe products that are only marginally more effective then placebo. And those very same experts got consumers to ask there HCP about treatments. Yes these are people who worked for the dark side but, they are the people who know communications and marketing. They are the people that know the science of medicine and can create strategies that change peoples opinions and drive action. And they are the people that providers tend to shun. 

Of course there are some sour grapes in my fruit basket and I will not deny that I must take responsibility for this but it strikes me that if we are to marshall a nation to know about and deliver high quality cancer care it should not be left to academics or clinicians alone. It requires all hands on deck and the talents and expertise of proven marketing and communications specialists with expertise not only clinical credentials. Whatever you think about those of us who worked for or are from the dark side we could drive a message, sell an idea, and get an Eskimo to buy ice cubes. The goals of IOM and cancer care will not be achieved quickly and easily. And will require disparate talents.