Because it is the right thing to do . . . We need to have answers
Because it is good for business . . .We need to be players
Because it is good for residents and family members . . . We get involved
We need to be subject matter experts on all things related to elders including how to think about death, dying and medical intervention. This does not mean we should ever make moral or value judgments about or on behalf of residents, but as leaders we need to be prepared to help them walk the path of making very difficult, no-good-options decisions.
Quality of Life
On July 23, 2015 The New York Times published an article titled “Benefit of End of Life Chemotherapy Questioned.” The article takes a hard look at the decision to use and continue chemotherapy or not and quality of life. Some interesting data:
- The generally accepted protocol is that if an individual is not able to provide for their own activities of life, an additional round of chemotherapy is not warranted.
- There has been a general belief that individuals with terminal cancer, but who are relatively healthy will benefit from another round of chemo. Benefit means either extending their lifespan or improving the quality of life for their remaining time on earth.
- It turns out that in many cases, life expectancy is not increased and quality of life is markedly decreased.
Walking the Path with Families
The easiest default when families are facing end of lifes about chemotherapy is to punt the discussion to physicians or the hospice nurse, and certainly they need to be a huge part of the conversation. The challenge is that at least today, the medical profession’s default position is to treat rather than not treat.
The do-everything-possible-to-extend-life-at-all-cost has sort of a noble ring to it, but if it results in nothing but pain and misery it may not be the real right choice.
We have this powerful opportunity to be passionate experts on how residents and families can evaluate these no-good options, difficult decisions. Just a few considerations:
- We can help them figure out how to wade through these decisions in the concept of their spiritual/religious belief systems.
- We understand better than most how thinking about and processing the complex trade-offs between gaining a few more days or weeks, the negative parts of chemo and radiation therapy treatments.
- We can help be a moderating, rational, compassionate voice as families wrestle with the right, the compassionate, thing to to.
- We can help them take advantage of hospice as a way to both improve quality of life and often extend a resident’s lifespan.
These are the kinds of things that can set you apart as a leader in your community and allow us a more influential place at the table in the broader aging and healthcare continuum.