Search

Context: Unlike primary care physicians in the U.S., it is only recently that Hungarian primary care physicians have had the educational resources for providing end-of-life care and the availability of hospice services as part of the Hungarian health care system., Objectives: The aim of this study was to assess, compare, and contrast beliefs and practices of end-of-life care held by primary care physicians practicing in selected regions of the United States and Hungary., Methods: A 22-item questionnaire, written in English, translated to Hungarian, and pilot tested in both countries, was mailed to 339 Hungarian and 330 U.S. physicians, with response rates of 54% and 48%, respectively. Descriptive and bivariate analyses were conducted to compare the samples., Results: Over half of U.S. physicians indicated they were quite knowledgeable about hospice care and rated currently available services for the terminally ill as exceptionally good, compared to less than 10% of Hungarian physicians. The physicians' differing beliefs that discussing a terminal prognosis fosters a sense of hopelessness is consistent with disclosure beliefs and practices. The majority of U.S. physicians believe it is the patients' right to know and always tell them when the diagnosis is terminal. Hungarian physicians (44%) believe that the patient's right to know is balanced by the physician's judgment of the patient's best interest, and an additional 40% disclose only if asked., Conclusion: These results illustrate some of the important differences in physicians' beliefs about the care of terminally ill patients between the two countries and can be used to guide medical education and practice., (Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

Background: Helping families make end-of-life care decisions can be challenging for health care providers in an intensive care unit (ICU). Family meetings facilitated by palliative care consult services (PCCS) have been recommended and found effective for improving support for families in these difficult situations. These services can be improved with a deeper understanding of factors associated with emotional burden in the aftermath of end-of-life decision making., Objective: This qualitative study seeks to provide a better understanding of family experiences and emotional burden surrounding end-of-life decision making., Participants and Methods: We conducted in-depth, semistructured interviews with 23 family members following the death of a loved one in the ICU. All participants had been involved in a PCCS-led family meeting concerning end-of-life decisions about their loved one. Methodology from grounded theory was used to analyze the content of transcripts and to build a theoretical model., Results: From the perspective of the family, decision making at the end of life is described within a theoretical model of salient experiences that are relevant to families' emotional burdens. Three temporal stages were evident: (1) the illness experience, (2) decision making in the family meeting, and (3) the dying process. However, emotional burden in the form of lingering questions and resentment was more common when families reported having negative experiences during the final hospital stay., Conclusions: Supportive responsiveness from the PCCS for families who have experienced critical incidents or who have unanswered questions or resentment about treatment may be an important consideration to alleviate later emotional burden.

The widespread need for palliative care has prompted the development of hospital-based palliative care consult services to provide a more interdisciplinary approach to managing advanced illness and end-of-life concerns. Establishing a successful consult service is a challenging task. This is a descriptive study of the development of a palliative care consult service (PCCS) within a non-profit, multi-hospital health system, and the five successful strategies used to optimize growth over the first five years. The PCCS is a mobile interdisciplinary team established to provide accessible, comprehensive end-of-life care and symptom management to patients with advanced illness within the health care system. Critical to its success, the team developed and maintained a database to document growth and ensure continuous quality improvement. A description of this database is provided, along with current performance outcomes. The program has prospered since its inception in 2002, with a 47% average annual growth over the first five years. The PCCS now averages 110 consults per month and has treated more than 3500 patients. This growth can be directly attributed to the five key strategies that have been used to plan, develop, and expand the program.

Introduction: Death and dying are taboo topics in Hungary. The care of the dying, the adequate relief of their symptoms, and the psychosocial and spiritual support of both patients and their relatives are not yet well addressed. As a preliminary study, we obtained information about the feelings and thoughts of Hungarian patients on death and dying, and about their expectations for end-of-life care., Methods: A questionnaire was mailed to a convenience sample of 29 adult primary care offices where a total of 845 unselected patients completed the questionnaire., Results: Only 19% of respondents would prefer to die in a hospital; while 69% of respondents would like to receive end of life care in their home. Respondents' greatest fear was to lose their autonomy and be dependent on their caregivers (55%). The second most noted concern was fear of pain and suffering (38%)., Discussion: The majority of Hungarian patients visiting their primary care physician's office prefer to receive end-of-life care in their own home. This mirrors findings in other European countries. It would appear that hospice and palliative care approaches would be acceptable to the Hungarian public if they were to be broadly developed.