Discussing hospice with your patient
It is never easy to tell your patient that he or she is terminally ill. Here are suggestions for initiating the discussion of hospice care and offering your patient hope for a higher quality of life.
How to deliver difficult news
It is never easy to deliver the difficult news that you believe your patient is terminally ill. Yet when you offer hospice care as part of your discussion, it is also an opportunity to give your patient hope for a higher quality of remaining life. Here are some suggestions for how to initiate the discussion of hospice care (Source: Advice from Creagan, 1994 and Faulkner, 1994):
- Choose a private area where there will be no interruptions. As much as you may want to get this over quickly, you will show more care and concern if you have an unhurried presence.
- Sit down with your patient, family and caregivers. It is always best if the patient is not alone to receive this difficult news.
- Use plain, easy-to-understand language to offer an overview of the patient's health situation, the diagnosis and its implications. Do not assume your patient or the caregivers will understand everything you say. Check with them as you discuss each aspect and make it easy for them to ask questions.
- Be prepared to repeat information several times if necessary. Allow time to recognize your patient's and caregivers' emotional reactions.
- Find out your patient's, the family's and caregivers' specific concerns and address them.
- Without overwhelming the patient and family, provide options such as hospice care. Assure them that hospice care is not about giving up hope, it is about living, loving and making every day count.
- To the extent possible, offer a general estimate of your patient's expected length of survival.
How to discuss hospice care and make timely referrals
"Through my years as a hospice doctor, I have learned that dying does not have to be agonizing. When people are relatively comfortable and know that they are not going to be abandoned, they frequently find ways to strengthen bonds with people they love and to create moments of profound meaning in their final passage."
Ira Byock, M.D.
Physicians have many reasons why they delay talking about hospice with their patients and their patients' families. You may share some of their reasons, too.
- Perception that a referral to hospice care is "giving up" on the patient
- Discomfort with dying and death
- A sense of personal failure for not being able to cure your patient or prolong life
- Lack of information about Hospice at Home services
- Uncertainty about the appropriateness of a hospice referral
But there are convincing reasons to talk about hospice care with your patient before there is a medical crisis. Hospice care is most effective when provided over the period of several months. Research published recently in the New England Journal of Medicine found that "With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival."
This and other studies indicate that life can be prolonged by 20 to 69 days when palliative and hospice care is offered as soon as it is appropriate. Yet nationally, 50 percent of all patients die within one month of admission into hospice care and a full 20 percent die within the first week of care because referrals come too late in the life journey.
While Hospice at Home is usually able to control the physical pain and suffering of late-referred patients, time limitations constrict the Hospice team's efforts to provide adequate spiritual and emotional support. For the comfort of your patients and support of their caregivers, we want to encourage you to make your palliative and hospice care referrals as early as appropriate.
Some compelling reasons to introduce hospice care earlier to your patient include:
Pain Management Medical Care — Your patient's pain management and comfort is Hospice at Home's primary concern. Our medical professionals stay abreast of the latest in pain management techniques. They are adept at teaching your patient's family members or caregivers how to administer medication by a variety of means. Most of these pain management medical treatments can be provided in the patient's home, but should more extensive care be required, Hospice at Home will assist in locating a facility that will meet your patient's and the family needs.
Emotional and Spiritual Support — Your patient's hospice care team includes a spiritual counselor who will help your patient and the family come to terms with the process of dying. The spiritual counselor will assist your patient in completing some of those important tasks associated with dying, such as saying final good-byes, mending broken relationships, and giving and seeking forgiveness.
Practical Support — The chores of daily living can be overwhelming to the caregiver. Your patient's hospice team can relieve some of the burden by providing home health aides to assist in the grooming of the patient and to help with household tasks. Hospice at Home volunteers also can perform many functions, including sitting by the bedside, to allow the caregiver an opportunity to take a break from continuous care.
Financial Relief — Most patients in hospice care access the Medicare hospice benefit. This benefit covers medications and equipment related to the terminal illness, visits by medical and nursing professionals, home health aides, short-term inpatient care and bereavement support for the family following your patient's death. Hospice at Home also accepts Medicaid and private insurance. The financial services specialists at Hospice will assist in negotiating with individual carriers. When financial resources are not available, no one is ever turned away from services thanks to the generosity of donors who fund Hospice at Home's Benevolent Care Fund.
Bereavement Care — The time after your patient dies can be very difficult for family members and friends. Hospice at Home's bereavement care staff will follow the family for a full 13 months after your patient's death. In addition to monthly newsletters sent to the family, Hospice at Home offers short-term bereavement education classes and long-term bereavement support.