As a mother, daughter, and friend, I have spent my fair share of time in emergency rooms. It can be grueling-- even when the reason for the visit is fairly trivial. A broken collar bone, a hand-full of stitches, or a tummy ache from eating too many gummy bears.
But as a caregiver for someone with end-stage cancer, those minutes can feel like hours, and hours like millennia. I can't begin to imagine how uncomfortable those same moments feel for the one who is actually struggling with the final stages of cancer.
Thinking those same thoughts - that ER visits can be "disruptive, distressing, and exhausting" - and understanding that roughly 40% of people visit the ER in the final 2 weeks of life, researchers in Canada decided to look at the reasons why those visits happen. Could some of these reasons be avoidable?
In their study of over 90,000 people, the number one reason for ER visits for cancer in the final 2 weeks of life was listed as lung cancer. With tears in my eyes I dug deeper into the findings. Other reasons for visits included dyspnea (shortness of breath), abdominal pain, pneumonia, and fatigue, as well as dehydration, pleural effusion, and altered consciousness.
Certainly some of these reasons are unavoidable. But couldn't we be doing more to anticipate the underlying theme behind many of these visits? An inability to cope with the end-stage symptoms of cancer due to lack of support and resources?
The author's suggest that we need to find better ways for people to get the support resources they need at home, or a way that those wishing residential hospice care can be transferred directly from home, rather than spend those agonizing moments in the ER.
What can we do?
Talk with your oncologist or your loved one's oncologist about end-of-life symptoms before they occur. Having a list of questions to ask can be very helpful. (If you enrolled in a hospice program, many of these questions will be addressed.) For example:
- What can we do at home if Aunt Mary becomes more short of breath?
- What can we do to manage her pain if it gets worse?
- What can we do if she becomes constipated?
- What resources are available to help with care giving?
- How can we cope (both patient and caregiver) with the relentless fatigue of end-stage cancer?
- If symptoms become too difficult to manage at home, is there a way that you or your loved one can arrange a direct transfer to a residential hospice facility?
Often, knowing a little about what you can expect (even though many of us hesitate to ask that question), can lessen some of the anxiety that is inevitable during the final stages of cancer, and allow you to ask for the help you need before you need it.
Further Reading:
Photo: istockphoto.com
Source:
Barbera, L. et al. Why do patients with cancer visit the emergency department near the end of life?. Canadian Medical Association Journal 2010. DOI:10.1503/cmaj091187.
