Running head: COMPLETED SERVICE LEARNING PROJECT 1

Your name:

LaDonna Henderson

Date:

August 14, 2017

Discussion of completed service learning project:

For my service-learning project, I narrated an oral discussion of the role of palliative and hospice

care in end-of-life care. Palliative care is often confused with hospice care. I will explore their similarities

and differences and discuss what each has to offer patients and families.

Many times, when people hear the word hospice, they automatically associate it with death and

do not wish to discuss it as a treatment option. However, hospice is not about dying but about living. If

only we can get the general public (as well as all health care professionals) to understand this, it would help

tremendously in providing excellent end-of-life care (Galicia-Castillo, 2011, p. 2219). Hospice care is a

part of palliative medicine and is usually delivered within the last six months of life when curative

treatments are no longer being pursued. Studies have shown that people in hospice care live longer than

patients getting curative treatment for the same illness (For hospice care, sooner is better, 2014).

The focus of palliative care is on symptom management and improving quality of life in patients

with a terminal illness. Palliative care, according to Dr. Galicia-Castillo, a geriatrician board certified in

hospice and palliative medicine, can be delivered concomitantly with curative medicine and can occur at

any time during a disease process (2011, p. 2219). The goal of palliative care is to manage end-of-life

symptoms while optimizing the quality of life throughout the dying process (Rome, Luminais, Bourgeois,

& Blais, 2011, p. 349).

The most important thing that palliative care and hospice care have in common is taking care of

people who are dying. Generally, a person is eligible for hospice services are eligible for hospice service
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when there is a terminal prognosis is made with a life expectancy of less than six months. Eligibility for

palliative care has no such time constraint and, in fact, the earlier it is started the better.

Evaluation of the selected intervention:

My selected intervention was encouraging patients to identify desired end of life choices based on

increased understanding of the role of palliative care versus hospice care. Advance care planning is a

communication process wherein people plan for a time when they cannot make decisions for themselves. It

includes reflection, deliberation, and determination of a persons values and wishes or preferences for

treatments at the end-of-life ("Improving end-of-life communication and decision making," 2015)

Goal #1: Create a shared understanding among patients, families, and healthcare providers

regarding what care choices are important to patients. Patients with long-term and/or terminal illnesses have

often lost control over many things. Advance care planning gives patients back some control over their life

how they want to be treated when seriously ill. It lets them plan how they want to be treated when faced

with a terminal prognosis.

Goal #2: Identify a healthcare proxy (HCP) who will make healthcare decisions if the patient

becomes unable to do so. It is important that the patient select someone they trust to make significant

decisions based on his or her understanding of the patients values, beliefs, and desires. If a patient has not

named a HCP, most states a default hierarchy that is used to identify who can make decisions if the patient

is unable; for example, if married, then the spouse would become the HCP by default.

Discuss how this project contributed to professional collaboration & community engagement:
COMPLETED SERVICE LEARNING PROJECT 2

As I chose to give an oral presentation on my topic, no specific project was done. However, in

considering professional collaboration and community engagement, I would like to explore a program that

would address my nursing intervention and meet the two goals I identified. Again, my intervention was to

encourage patients to identify end of life choices. It is not necessary for patients to be at end of life before

deciding what kind of care they want. Rather, the earlier advance care planning is addressed, the better

prepared the patient, family, and healthcare providers are to ensure the patients desires are accomplished.

Consider the following statistics:

60% of Americans report that they want their wishes respected at the end of
life

70% of those Americans have not completed an advance directive

80% of those diagnosed with a terminal illness want to have an end-of-life

conversation with their physician (Five Wishes [PDF], 2011).

Bridging the gap between the percentage of people who want their wishes respected at end of life and those

who actually have taken steps to make sure that happens is an important task for healthcare providers.

Starting the discussion is not always easy, even for those in the healthcare field. One program that makes

this process easier and simpler is Five Wishes, created by the nonprofit organization Aging With Dignity.

It is an easy to use advance directive tool that asks simple questions written in plain, easy to understand

language that help a person think about important end-of-life issues. It is often called the living will with a

heart and soul (Aging with Dignity, 2017).

Five Wishes simplifies advance care planning by dividing the process into five steps, or

wishes. Each wish addresses a different aspect of care planning. When it is completed, patients desires

for how they want their healthcare to be addressed are clearly addressed and a healthcare proxy is

identified. Once the Five Wishes document is signed and witnessed, it becomes legally binding and

supersedes any previous documents. It meets state requirements in 42 states, including Maryland (Five

Wishes [PDF], 2011).

Advance care planning can involve more than just the patient. Families, doctors, lawyers, financial
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planners and even friends can participate in helping a patient make important decisions about care options.

It is best to start advance care planning before you actually need it. This will help ensure that quality

healthcare continues until the very end of life.

Reference:

References

Aging With Dignity. (2017). History and Mission. Retrieved from https://agingwithdignity.org/about-us/history-and-

mission

Five wishes [PDF]. (2011). Retrieved from https://agingwithdignity.org/docs/default-source/default-document-

library/product-samples/fwsample.pdf?sfvrsn=2

For hospice care, sooner is better. (2014). Retrieved from https://www.hospicesect.org/hospice-and-palliative-care/for-

hospice-care-sooner-is-better-2

Galicia-Castillo, M. (2011). Palliative care and hospice [Letter to the editor]. Health Affairs, 30(11), 2219. Retrieved from

http://proxy-fs.researchport.umd.edu/login?url=https://search-proquest-com.proxy-

fs.researchport.umd.edu/docview/908419456?accountid=27669

Hospice care. (2012, October). Retrieved from https://www.cancer.gov/about-cancer/advanced-cancer/care-

choices/hospice-fact-sheet

Hospice vs. palliative care. (2017). Retrieved from http://www.caregiverslibrary.org/caregivers-resources/grp-end-of-life-

issues/hsgrp-hospice/hospice-vs-palliative-care-article.aspx

Improving end-of-life communication and decision making. (2015, June). Retrieved from

http://www.sciencedirect.com/science/article/pii/S0885392415000445

Meier, D. E. (2011). Increased access to palliative care and hospice services: Opportunities to improve value in health
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care. Milbank Quarterly, 89(3), 343-380. doi:10.1111/j.1468-0009.2011.00632.x

National Hospice and Palliative Care Organization. (2015). Facts and figures: Hospice care in America [PDF]. Retrieved

from https://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf

Palliative care in cancer. (2010). Retrieved from https://www.cancer.gov/about-cancer/advanced-cancer/care-

choices/palliative-care-fact-sheet#q1

Radulovic, J. (2016, August). Facts about hospice care. Retrieved from http://hospiceactionnetwork.org/facts-about-

hospice-care/

Rome, R., Luminais, H., Bourgeois, D., & Blais, C. (2011). The role of palliative care at the end of life. The Ochsner

Journal, 11(4), 348-352. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241069/pdf/i1524-

5012-11-4-348.pdf

Sabatino, C. (2015, October). Myths and facts about health care advance directives. Retrieved from

https://www.americanbar.org/publications/bifocal/vol_37/issue_1_october2015/myths_and_facts_advance_direct

ives.html

What end of life care involves. (2015, September). Retrieved from http://www.nhs.uk/Planners/end-of-life-

care/Pages/what-it-involves-and-when-it-starts.aspx