Such training has changed the way providers talk to their patients.
“I recently had a patient with terminal brain cancer,” said Carl Demars, MD, a physician with Mid Coast
Medical Group-Bath Internal Medicine who is board certified in hospice and palliative care. “She was young
and felt very alone. She had done well on an experimental chemo, but that came to an end and her cancer
was progressing. I used some of the skills I learned at the Annual Hospice/Palliative Care Convention about
discussing serious life-threatening illness. I asked about her goals and what she knew about her prognosis.
What was important to her in the coming weeks and months? She let me know she knew she was terminal
and wanted to be with other young cancer patients to gain support. I asked our social worker to help me find
something for her and they found a support group that meets at the Dempsey Center that the patient is now
attending. This kind of connection was not part of traditional medical care in the past, but it is so important for
patients.”
For another patient, her final wishes prescribed how her treatment would proceed, said Jess Vickerson, FNP,
MSW, a palliative care nurse practitioner at Mid Coast Hospital. The patient, who had terminal cancer,
wanted to spend her final days living with her son and grandchildren who lived out of state. After she had her
final chemotherapy treatment, she had a palliative care consult and was referred to the Bodwell Nursing and
Rehabilitation Center at Midcoast Senior Health Center so she could receive focused rehab to get her strong
enough to make the long trip.
When patients are able to tell their healthcare providers what level of treatments they want, it saves the system
money, because emergency room visits and hospital admissions are reduced. But it doesn’t necessarily save
the hospital money. Because the system pays hospitals for the care they give, not the care they don’t, hospitals
make less money when there is less intensive care at the end of life. And, the reimbursement system doesn’t
yet pay for talking to patients about advance care planning. Medicare recently proposed paying for such
conversations—a welcomed development.
Nevertheless, Mid Coast providers are continuing to have conversations with their patients because, as
Chalmers said, “It’s the right thing to do.”
When patients are able to tell their healthcare providers
what level of treatments they want, it reduces ER visits
and hospital admissions.
Mid Coast Health Services
