Student project aims to correct hospice perceptions

Geriatrics isn’t the flashiest field in medicine when compared to…

Geriatrics isn’t the flashiest field in medicine when compared to emergency surgery or cutting-edge neuroscience, but the six University of Pittsburgh graduate students who meet in a lofty Cathedral of Learning conference room don’t seem to care.

In fact, the six master’s students from Pitt’s Graduate School of Social Work are dedicated to the world of geriatrics, and they are translating that dedication into a project addressing common misconceptions of hospice care.

“We are concerned that older patients are not taking advantage of the benefits available as a part of hospice care,” said Mara Krotec, who works on the project. “Our concern comes in large part because too many people see a physician’s referral to hospice as a death sentence — as the end.”

The goal of their project, which the students developed independently from professors and advisers, is not to raise the number of hospice referrals but to increase public awareness about what hospice care entails.

Entering a hospice is a constructive palliative decision, which shifts the emphasis away from developing a cure toward the management of symptoms. Hospices are typically recommended for patients with a prognosis of less than six months, or when a physician decides active and aggressive treatment will do nothing but hasten a patient’s death.

Students involved with the project include Krotec, Jen Marasco, Lynnae Stern, Tami Marie Krzeszewski, Joe Osiecki and Christopher Messersmith. Most of their work to-date consisted of interviews with medical professionals and conducting statistical analysis.

They operate under a series of grants from the Hartford Partnership Program for Aging Education and receive regular oversight from Beth Mulvaney, a social work field adviser at Pitt.

Mulvaney expects the students’ goal will come to fruition when they present their findings to professionals in the geriatrics field in the Cathedral on April 21.

The six students plan to elaborate on their work in front of professionals from national and local social work agencies who assisted the students over the past several months, Mulvaney said. These include field instructors, directors, administrators and local community members from within the Hartford Partnership.

The decision to enter a hospice is usually made after a recommendation by the primary physician, which is why the students’ project is primarily targeting professionals in the medical community. Currently the average stay in a hospice is only 12 days, in spite of the fact that hospice benefits are available for up to six months.

“We are pushing to start the hospice conversation with doctors and other professionals,” Osiecki said. “The more we talk about hospice care, the more benefit patients will be able to get out of it. If we can raise the average hospice stay to even 20 or 30days, that would be a major success.”

A social worker is responsible for arranging a diverse array of benefits while a patient undergoes hospice care. The benefits include easier access to medicines and other services to improve the quality of a patient’s day-to-day life. The social worker operates alongside nurses and physicians to make whatever time a patient has left as comfortable as possible.

Counseling services are also arranged for family members and can continue even after the patient dies.

“We live in a death-phobic society,” Mulvaney said. “Too many patients and physicians see hospice referrals as a resignation to death, as giving up too early, and so they are blinded from the benefits.”

Through intensive hospice care and the alleviation of symptoms, some patients even begin to rebound — in which case the decision to enter hospice can be reversed and aggressive treatments can begin again.

Mulvaney was quick to point out that patients do not typically rebound after entering a hospice, but it is important for patients to consider the potential benefits of palliative care.

“It is often difficult for patients and their families to develop the distanced perspective needed for appropriate hospice referral,” Marasco said. “Which is exactly why our project is a vital one. We need to foster the conversation.”