How do I talk to my patient about hospice?
All too often families tell us, "We wish we had known about hospice sooner." For them and their loved ones, it is never too early to talk about hospice.
Here is a suggested plan for introducing hospice as an end-of-life option to your patient.
Identify other decision makers: few people make end of life decisions alone
- Who do you rely on to help you make important decisions?
- Who in the family should be with us when we discuss results?
Assess understanding of prognosis; identify gaps in patient's knowledge
- What do you understand about your condition?
- Do you think you will get better, worse, or stay the same over the next few months?
- In the next few weeks, there will be some choices that you'll need to make, and I'm here to help you make them.
- Provide general estimates of how long a patient will survive and how his or her condition will progress.
Define the goals for care for patient and for family members
- What do you hope for most over the next few months?
- Is there anything you're afraid of? Anything you need or want to do?
Reframe goals, admit limitations
- I wish we could guarantee ... but unfortunately we can't.
- Perhaps we can ... instead.
Identify needs for care
- It can be difficult to care for a family member at home; no one can do it alone. Have you thought about what kinds of help you might need?
- Would it help if we could send a nurse to your home to check on you?
- Are there any financial, emotional, spiritual issues you would like help with?
Summarize and link goals with care needs
- It sounds like your main goal is to stay at home and be with your family and remain in control of your care.
- I can tell that you want to be as independent as possible and not be a burden to your family. Having a nurse visit at home and having some help around the house might make that possible.
Introduce hospice as a way to achieve goals and meet needs
- One of the best ways to give you the help you will need to stay at home with your family is hospice. Have you heard of hospice?
- Hospice is able to provide more services and support at home than most other home care programs. The hospice team has a lot of experience caring for seriously ill patients at home.
- Hospice helps people die naturally in their own time and helps people live as well as they can for as long as they can.
Respond to emotions, reaffirm your role, recommend hospice, provide closure
- I can see it's not easy for you to talk about this. Tell me what's upsetting you the most.
- I usually recommend that hospice get involved for patients at this stage of their illness.
- I will continue to be your physician while you are with hospice and will work with the hospice team to ensure you remain pain free and comfortable.
- I think hospice would be your best choice right now, but of course the final decision is yours. Think this over for a day or two.
- You know I will continue to care for you whatever decision you make.
- If you want, I can arrange for a hospice nurse to visit you so you can decide for yourself whether hospice is right for you.
Used with permission from Annals of Internal Medicine
Many terminally ill people fear pain, helplessness, and abandonment. Family members worry about being able to take care of their loved one. By sharing how hospice addresses these concerns and supports family members you can offer hope for higher quality at the end of life.
Hospice may not be a comfortable topic to bring up with your patient. By listening to your patient's concerns, hopes, and fears, you may find openings to introduce hospice as a way to meet needs and achieve goals.