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To the Editor: Dr Lynn¹ highlighted dilemmas that patients, their families, and their primary care physicians face at the end of life. The case of a 47-year-old man with advanced colon carcinoma illustrates serious gaps in care for those with chronic and life-threatening illness nearing end of life. The current hospice model may not address all the problems that Lynn describes, but substantial effort is being directed toward expanding hospice beyond traditional oncology care. Hospice programs may need to obtain funding for more comprehensive services, but this does not necessitate eliminating an existing reimbursement mechanism for end-of-life care, as Lynn suggests.

Innovative programs like the Center to Advance Palliative Care at Mount Sinai Medical Center in New York, NY, are examining successful hospital-hospice collaborations that seek to bridge the gaps in care. There is still a need for sound community-based hospice programs that can support patients and families as they . . . [Full Text of this Article]

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