RESUMO
Black Americans are more likely than whites to choose aggressive medical care at the end of life. We present a retrospective cohort study of 2843 patients who received a counselor-based palliative care consultation at a large US southeastern hospital. Before the palliative consultation, 72.8% of the patients had no restrictions in care, and only 4.6% had chosen care and comfort only (CCO). After the consult, these choices dramatically changed, with only 17.5% remaining full code and 43.3% choosing CCO. Both before and after palliative consultation, blacks chose more aggressive medical care than whites, but racial differences diminished after the counselor-based consultation. Both African American and white patients and families receiving a counselor-based palliative consultation in the hospital make profound changes in their preferences for life-sustaining treatments.
Assuntos
Negro ou Afro-Americano/psicologia , Cuidados Paliativos/psicologia , Preferência do Paciente/etnologia , Assistência Terminal/psicologia , População Branca/psicologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Comportamento de Escolha , Aconselhamento , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Educação de Pacientes como Assunto , Assistência Terminal/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: A large tertiary hospital in central Georgia has found a novel approach to hospital palliative care. APPROACH: It is unique in that the approach has a strong counseling base in providing the palliative service, rather than major reliance on advance practice nurses or palliative physicians. The Medical Center of Central Georgia employs master's prepared counselors who spend the hours needed to assist families in making difficult end-of-life decisions. MODEL: Using a family systems therapy approach, these counselors have developed the Transitions and Palliative Care Therapy Model, which has proved to be a successful means of providing the services. The model includes the "7 Core Components of Communication and Decision Making," which gives the counselors actual interventions to use in working through these complex cases. OUTCOMES: The growth of the program over 7 years is staggering with the outcomes far exceeding even the predicted volume from the Center to Advance Palliative Care. CONCLUSIONS: The model has the counselor at the heart of the team, keeping the communication open and flowing. The Transitions and Palliative Care Therapy Model has become an accepted standard of practice at Medical Center of Central Georgia and continues to be a successful means of managing the most complex cases in the hospital.
