VITAS Advantage: Case Study on 24/7/365 Care Support for Physicians
Case Study: Patient with Advanced Lung Cancer
MK* is a 67-year-old, oxygen-dependent ex-smoker who is undergoing chemotherapy and radiation for advanced lung cancer, and receiving opioids for pain. His 66-year-old wife is his primary caregiver at home. MK is referred to VITAS for hospice care when he is too ill to visit his oncologist for nausea, vomiting, constipation, progressive weight loss, and new pain in his shoulder and lower thoracic region.
His individualized hospice care plan includes visits by a VITAS nurse three times a week for symptom and pain management, daily visits by a hospice aide for personal care, ongoing goals-of-care conversations with his VITAS hospice physician, and support from a respiratory therapist. VITAS delivers MK’s hospice-related medications, oxygen, supplies, and a hospital bed to his home.
For two days during MK’s first week of hospice enrollment, VITAS provides temporary 24-hour bedside care (Intensive Comfort Care®, or ICC) per Medicare requirements to ease MK’s worsening breathing, agitation, pain, and dehydration. Several days after ICC is withdrawn, MK dies peacefully at home surrounded by his wife and grandson.
*These initials represent an anonymized patient and are used for the purposes of education only.
Hospice Services ‘Must Exceed Available Community Resources’
A 2020 Australian study finds that hospice care provides clear benefits to patients with cancer as they approach the end of life, including enhanced quality of life for patients and their families, improved symptom control, and more time away from inpatient care.
Hospice services, they point out, must “exceed available community resources” in order to keep patients in their preferred care settings and to support caregivers. Services such as 24/7/365 availability for symptom management and ongoing caregiver education, according to the study’s findings, are “more likely to be clinically appropriate with fewer hospital visits, shorter lengths of stay, and less time in intensive care units if hospice is engaged.”
Caregivers also report lower rates of depression and improved ability “to move on with life after the patient’s death” if they have benefitted from ongoing support from an interdisciplinary hospice team.
Supportive end-of-life care keeps patients where they and their hospice providers want them to be: at home, surrounded by familiarity and comfort.
VITAS provides 24/7/365 clinical support in two distinct ways:
- Telecare provides caregivers and healthcare providers 24/7/365 access to VITAS clinicians who can triage and manage symptoms over the phone or dispatch a clinician to the bedside, if necessary, to resolve crises
- Intensive Comfort Care® involves continuous care provided by nurses or aides at the bedside for up to 24 hours per Medicare guidelines to manage severe symptoms and pain.
Source: Currow, D., Agar, M., & Philllips, J. (2020). Role of Hospice Care at the End of Life for People with Cancer. Journal of Clinical Oncology, 38(9), 937-943. DOI: 10.1200/ JCO.18.02235