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Web Site on Advance Directives

Looking for information for your client's advance directives? Try The site is sponsored by the American Hospital Association along with Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO). Listed are advance directives for all states, which can be downloaded in PDF format. Other resources include a brochure regarding basic facts concerning advance directives. This brochure is available for download or can be ordered in bulk from NHPCO. There is also a printable version of an ID card that can be carried in your wallet with your advance directive information. A link will take you to "Ten Myths About Advance Directives," an article written by Charles P. Sabatino, JD. Additional resources include a Consumer Tool Kit for Health Care Advanced Planning. The kit contains 10 tools consisting of self-help worksheets, suggestions for writing advance directives, and additional resources. The tools contained in the kit assist the user in identifying priorities regarding quality of life. Various resources are also available in Spanish. Additional information can be obtained from the National Hospice and Palliative Care Organization at or by calling the help line at 1-800-658-8898

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Clinical Practice Guidelines for Quality Palliative Care

Interested in guidelines for palliative care? Log on to and download guidelines for free. They can be downloaded in both full-text and executive summary versions. These are the first set of clinical guidelines for palliative care in the United States. In December 2001, a group of palliative and hospice care leaders formed the National Consensus Project for Quality Palliative Care (NCP) Steering Committee to develop these guidelines. The guidelines are intended to set standards and establish uniformly accepted definitions of palliative care. There are eight domains designed to address the issues of those in need of palliative care. For more information regarding the guidelines or the NCP, contact Ken Zuroski, NCP Project Coordinator, by telephone (412-787-1002) or e-mail (

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Free Online Pain Management

Three of the nation's leading providers of health services and information joined together to offer The Last Chance for Comfort: An Update on Pain Management at the End of Life, which was released in September 2005. VistaCare, NHPCO, and WebMD have sponsored the free course designed for physicians, nurses, nurse practitioners, and other healthcare professionals. Included in the course is an overview of pain management, pain myths, ethical issues tied to pain management, suggestions on holistic approaches to pain, and effective pain management strategies in various settings. Continuing education hours are available after successful completion of the course. Free registration for the course is available at For additional information, contact Mike Fleming at


Hospice Statistics Released November 2005

The National Hospice and Palliative Care Organization in Alexandria, Virginia, reports that 1,060,000 patients were serviced by hospice providers in 2004. This is an increase of more than 100,000 from 2003. The percentage of people who were treated with cancer diagnoses dropped to 46%. Hispanics accounted for 6.2% of hospice patients in 2004, an increase of more than 2% from the previous year. J. Donald Schumacher, president and CEO of NHPCO, stated the group is seeing an increased number of people seeking information about care at the end of life well before they are faced with a health crisis. There have been more than 1 million visitors to the Caring Connections Web site. More than 30,000 people have used the toll-free HelpLine in search of living wills or advance directives. Caring Connections offers information on hospice and palliative care, state-specific directives, and other materials free of charge. For more information, log on to or call the HelpLine at 1-800-658-8898.


Drug Approved to Treat Rare Leukemia and Lymphoma

The Food and Drug Administration (FDA) has approved Arranon (nelarabine), a drug for treating children and adults with T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma whose disease has not responded to or has relapsed after at least two chemotherapy regimens. This is the first drug released to treat this limited patient population. According to Dr. Steven Galson, Director of the FDA's Center for Drug Evaluation and Research, Arranon has shown to be effective as a last-resort treatment in certain populations. The drug is a cancer chemotherapy drug and kills cancer cells by blocking the cells' ability to reproduce. Arranon has been released for marketing under the FDA's accelerated approval program based upon the early evidence of its effectiveness. Additional studies are ongoing to verify Arranon's clinical benefit. Common side effects include fatigue, nausea, vomiting, and diarrhea. Arranon will be distributed and marketed by GlaxoSmithKline (GSK) of Research Triangle Park, North Carolina.

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To learn more about this drug, log on to


Available in Spanish Surgery Choices for Women With Early-Stage Breast Cancer

The Agency for Healthcare Research and Quality (AHRQ) and the National Cancer Institute have released a new booklet to help Hispanic women with recently diagnosed early-stage breast cancer. The book includes evidence-based information regarding lumpectomy, mastectomy, and mastectomy with breast reconstruction surgery. Using this information, the patient can discuss the various options available and choose the one that is best for her.

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According to the American Cancer Society, breast cancer is the leading type of cancer among Hispanic women. AHRQ Director Carolyn M. Clancy, MD, noted most women operated on for early-stage breast cancer live long lives, but which surgery they choose can have lasting effects on how they look and feel.


The booklet is available online in Spanish at It is available in English at Free copies can be ordered from AHRQ Publications Clearing-house by calling 1-800-358-9295.


New Affiliation Strengthens Quality for End-of-Life Care

The NHPCO and Americans for Better Care of the Dying (ABCD) announced their affiliation. Both organizations share a goal to improve care at the end of life. According to Charles Sabatino, Esq, chair of ABCD's board, "The affiliation of our two organizations will increase the available resources and maximize capacity for outreach, education, and research."


Future activities of the two organizations will build on the history of ABCD and complement the work of Caring Connections. Caring Connections is the NHPCO consumer education initiative providing free information to the public.

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New Rule From Medicare to Improve Hospice Care

The Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the conditions of participation (CoP) for hospices. The new ruling will improve the quality of care for hospice patients and focus on care delivered to patients and their families. Outcomes of care are also included as part of the new changes. Existing CoPs do not contain a patient-centered, outcome-oriented approach to quality of care delivered by hospice. Under the proposed rule, more attention to meeting the specific needs of the individual patients is addressed.


Some of the changes include:


* Adding a patient assessment requirement


* Replacement of the current quality assurance requirement with a more comprehensive quality assessment and performance improvement


* Contracting for core services in certain situations


* Elimination of the requirement that a RN provide patient care in an inpatient facility on a 24-hour basis


* Guidance for hospices that care for residents in nursing homes



The proposed rule can be found at


Cancer Death Rates on the Decline

The annual Report to the Nation reveals that the death rate for cancer is still on the decline. The Annual Report to the Nation on the Status of Cancer 1975-2002 published in the October 5, 2005 issue of the Journal of the National Cancer Institute finds cancer death rates from all cancers combined dropped 1.1% from 1993 to 2002. The authors of the report state declines in death rates reflect progress in prevention, early detection, and treatment of the disease.

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This report has been issued annually since 1998 and is a collaboration among the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR).


The decline in deaths was higher for men than women with lung cancer, the leading cause of cancer deaths in both men and women. The rate at which new cancers are diagnosed for both sexes has been stable since 1992. Changes in these rates may be the result of changes in the prevalence of risk factors and changes in detection from increased screening and diagnostic techniques.


To read the full report, log on to, the Web site of the Journal of the National Cancer Institute.