Dear Editor:

I would like to commend you for publishing the outstanding phenomenological study by Drs Espinosa, Young, Symes, Haile and Walsh, which should be considered a landmark work.1 What their study clearly shows is that serious shortcomings still remain in how intensive care is practiced, since the landmark SUPPORT study of 1995 that revealed widespread problems in the intensive care unit practice.2

Although their study was relatively small and included only one 900-bed teaching facility, there is overwhelming evidence in the most current medical literature indicating that there is still widespread deficiencies in how end-of-life (EOL) care is practiced. Shortcomings in EOL care remain, despite the fact that most people still die in a hospital and, there is as much need for palliative care as there is for curative care.

Probably the most practical way to improve EOL care is to develop a palliative care certification course and then require all healthcare workers to attend a 1- to 4-day course, with a recertification every 2 years (similar to the required CPR and advanced life support courses). Such courses already exist for nurses3 and physicians,4 which could be used as a model to develop a new palliative care certification course. Relatively few nurses and physicians have completed the voluntary courses, mainly because the cost is prohibitive and because they are voluntary.

I am also doing what might be considered phenomenological work with a Web site called the American Society for Advancement of Palliative Care (ASAP Care).5 Besides providing information about palliative care by using evidence-based comments from published research, the Web site also has a discussion board where people can share their experiences with EOL care. Membership in ASAP Care is free by registering at the forum.

Thank you for sharing my comments with readers of CCNQ.

Sincerely,

-Michael Hahn, RPFT, RRT-NPS

7336 Peach Blossom Court Highland, CA 92346

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