A Current Guide to Processes of Care in Hospice

Abstract

Hospice and palliative medicine continues to emerge from being a fringe of the profession to being a core service for the health care industry. We have created standards of care, government regulations have defined core practices and the science of medical knowledge and patient practice has increased. Yet, the art of clinical medicine is still essential given that every patient and family presents with their own individual nuances within their unique spiritual, emotional, biologic, and social make-up. This creates a myriad of different clinical scenarios within our hospice and palliative care teams. Dr. Perry Fine has worked in hospice and palliative medicine since the inception of the Medicare hospice benefit. He combines his years of experience with the collective of our science and standards to create a true “companion” for the hospice clinician that fits into the pocket of a laboratory coat and covers most, if not all, situations we are likely to encounter in patient care. There are four main sections to the book. The first section, General Processes, provides an overview of how to approach hospice care using the interdisciplinary team (IDT) model. The chapter provides the natural progression different team members provide at different time periods before death. It includes a review of the roles and qualities of a high functioning team as well as documentation standards that need to be met. The second section reviews an alphabetical list of situations involving personal, social, and environmental processes—from Abuse in the Home to Suicide Risk. Every scenario has a section on findings, assessment, processes of care (the biomedical, psychosocial/spiritual, and practical aspect of intervention), goals/outcomes, and documentation in the medical record. The same pattern is used in the third section, Clinical Processes and Symptom Management for topics ranging from anxiety to xerostoma. There is an excellent section on pain management that includes the appropriate tables one would want to consult on this subject. Finally, the appendix contains helpful and up-to-date protocols on current subjects, such as palliative radiation, principles of pharmacotherapy, ketamine, clinical/functional assessment and staging, and anticoagulation. This book contains much-needed wisdom on a wide range of topics and is thorough in scope, full of practical advice, supported with evidence and balanced with experience to keep the IDT focused on the most appropriate outcomes. I cannot think of any scenario that has been ignored. Some sections are imbalanced, in that they are lacking in practical “how to” advice, but as a whole, the text provides helpful guidance through most scenarios. The Hospice Companion is written for the entire IDT with the section on personal, social, and environmental processes being useful for all disciplines, including social workers and chaplains. The section on symptom management is more helpful for medical practitioners (nurse and physician). In my opinion, the book is especially helpful for those team members starting in hospice or palliative medicine as a guide to lead them through their first year of working in this field. After reading this edition, I bought extra copies to give to the newest social workers, nurses, practitioners, and trainees on our team. Although there are helpful reminders for those working in the field for many years, most of the information will not be new to the experienced practitioner. That being said, I will also keep a copy to ensure I have not missed something when dealing with more complex cases. Tommie Farrell, MD, HMDC, FAAHPM, is a Family Medicine practitioner, Pathways at Hendrick, Abilene, Texas, USA.