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JAMA 25 Years Ago
November 15, 2000

St Christopher's Hospice, 1974

Author Affiliations
 

JAMA 25 Years Ago Section Editor: Jennifer Reiling, Editorial Assistant.

JAMA. 2000;284(19):2426. doi:10.1001/jama.284.19.2426

THE IMPACT of Cicely Saunders, OBE, FRCP, director of St Christopher's Hospice, London (Sydenham), on the care of the dying patient is persuasive.

After Dr Saunders had lectured at St Luke's Hospital Center, a Hospice Committee was established at St Luke's to consider the introduction of similar concepts within the framework of a university general hospital. Two members of the committee and I were invited to St Christopher's for an in-depth site visit in order to assist the committee in its deliberations.

I believe this report is factually correct, although it reflects my own intense positive involvement with a committee hospice staff.

First Impressions

First Impressions

Although I arrived with an initial resistance to continual contact with the dying patient, the actual experience was quite different from what I had expected. Instead of a terminal care or "death house" environment with cachectic, narcotized, bedridden, depressed patients, I found an active community of patients, staff, families, and children of staff and patients. . . .

First Impressions

The key personnel are full-time with many part-time and retired professionals, as well as volunteers, trainees, medical graduates, and young house doctors and nurses.

Accommodations

Accommodations

There are mainly wards, with few private rooms. Each bed has a colorful curtain around it, and there are some transparent, partial panels. Personal touches, such as flowers, paintings, comfortable lounge chairs, and wood, give a feeling of warmth. In addition to the wards, there are family rooms for visits and a large room for group activities.

Accommodations

On arrival, the patient is met at the ambulance by one of the staff. There is close face-to-face and bodily contact between the staff member and the arriving patient. The Hospice is designed so that the patient's bed is brought to the ambulance. From that moment, the bed remains the property of the patient. If the patient is bedridden, that bed becomes as mobile as a wheelchair. Once the patient is given a location in the ward, it remains his regardless of the deaths of surrounding roommates. . . .

Polypharmacy

Polypharmacy

"Polypharmacy" is the term coined by Dr Saunders and staff. The symptom manifestation, rather than the underlying pathologic characteristic, of the dying patient is paramount. Although emphasis is on pain alleviation, extensive drug therapy for a wide range of symptoms is also used. . . .

Polypharmacy

The object of polypharmacy is to maintain an integrated functioning individual who is neither in pain, nor symptomatic in any other area and who, if able, is alert to his surroundings and to the people about. . . .

Population

Population

Admissions come from many sources, but the Hospice prefers to select patients who have families or friends within commuting distance, to avoid the psychological difficulties inherent in isolating patients from their home ties. . . .

Population

The median length of stay is two to three weeks; 16% of the patients die within hours or 24 to 48 hours after admission. Some patients, despite prognosis, survive beyond six months, and some even survive for a number of years. . . . Long-term survivors are important for the morale of the staff and patients, dulling the impact of immediate or early deaths. . . .

Dignity of Death

Dignity of Death

Since the establishment of the Hospice in 1967, over 2,500 patients have been admitted, with eight to ten deaths occurring each week. There is 24-hour staff coverage (including physician and chaplain) at the time of the patient's death.

Dignity of Death

The actual event of death is managed with dignity. The dying patient is not isolated behind curtains. All patients in the ward area are aware of what is transpiring. The lack of suffering, in fact the absolute absence of patient distress, is the unique factor permitting the staff and other patients to overcome their fear of death. This applies equally to families and children who, on visits the next day, note the passing of a previous patient whom they had befriended. The curtain is drawn around the patient's bed at the very moment of death only, rarely before. The impending death of the patient concerns and absorbs the immediate staff on duty. The patient does not die alone and abandoned. . . .

Dignity of Death

The Hospice teaches a new attitude toward dying and death, with the realization and conscious acceptance of dying and death as part of being born and part of the struggle of life. . . .

Dignity of Death

JAMA . 1975;234:1047-1048

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