ABCD Exchange : March 1999 : President's Letter - Promises, Promises

Promises, Promises....
by Joanne Lynn

"Promises, promises," is not just the name of a Broadway musical - it is now the anchor of our approach to improving care at the end of life! We are learning that "promises" are a particularly powerful way to articulate the goal of better end-of-life care.

What is it that patients want most? A care system they can count on. It is not enough to suppress pain on a hospital unit, or to have only 40 percent of patients (down from 70 percent) with pain levels over 4 on a 10-point scale. In each case, patients would be a little better off, but they would not have much confidence in what was happening. Most believe that what happens to them is a matter of luck - good or bad!

How good do we have to be to inspire confidence? At some point, the current expectation of disaster must change to a demand for good care, and then to an expectation of good care. Then, people will no longer say that they were "lucky" that awful things did not happen as a loved one died - instead, they will say that their community’s services were just what was needed, when it was needed.

That scenario is a real revolution - a fundamental change in how we think about end-of-life care. But what do we need to promise? We will do well to start with these seven things:

  1. Patients will get good, evidence-based medical and nursing care.

  2. Symptoms will be prevented, treated, and kept from ever being overwhelming.

  3. Care will be continuous and comprehensive.

  4. Patients and families will be prepared with plans for problems that may arise.

  5. Patients and families will be able to make choices that reflect their values and preferences.

  6. The emotional and financial resources of patients and families are thoughtfully considered in making choices.

  7. Health care providers are focused upon helping to make every day count.

We at Americans for Better Care of the Dying are working to see that everyone can live - and die - in a care system that can promise these things! It would be quite a change, but we are all in this together, linked by a common goal of having a care system that works better in the future than it has in the past.

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This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.