A recent New York Times article discussed the importance of physician communication regarding end-of-life and hospice pointed out that in this country “we tiptoe around the D-word until so late in the game that even now, when more than 40 percent of Americans die under hospice care, about half do so within two weeks of admission. Even expert hospice teams can’t provide many of the elements of a good death.
While there has been a growth in hospice care, it appears that having end-of-life conversations have not become any easier. What can patients and family members do to enhance these types of conversations with physicians?
What do patients and their families want to know about hospice?
First, schedule an appointment with your physician before end-of-life decisions are necessary. What may prevent some from taking this step is actually not knowing what to ask, because caring for a terminally ill loved one and providing care as a physician bring two perspectives to the table. The National Cancer Institute lists some realistic questions and answers that may serve to guide and foster physician communication. The Hospice Foundation of America is an excellent resource because they provide information from different points of view.
What is the best strategy for starting an end-of-life conversation?
One question that is frequently asked is on how to keep loved ones in their home for as long as possible. Helpguide.org provides an excellent summary:
There isn’t a single specific point in an illness when a person should ask about hospice and palliative care; it very much depends on the individual. You may want to explore hospice care when:
- Your illness continues to progress
You’ve made multiple trips to the emergency room, your condition has been stabilized, but your illness continues to progress significantly, affecting your quality of life.
- Your symptoms are worsening
You’ve been admitted to the hospital several times within the last year with the same or worsening symptoms.
- You wish to remain at home
You wish to remain at home, rather than spend time in the hospital.
- You’re stopping treatment
You have decided to stop receiving treatments for your disease.
What does hospice provide and why is home healthcare needed also?
Hopefully, this information will guide you as you start to think about the process. One last word that may help you — remember, hospice care focuses on the needs of both the patient and family and we recommend that you choose a team that is interdisciplinary. Kim Guerci, Director of Operations for Caring People Home Healthcare, reminds us of the importance of having the Advance Directive and End-of-Life conversation not only with our physicians but with each other.
“Hospice care is a philosophy or approach to care rather than a place. Care may be provided in a person’s home, nursing home, hospital, or independent facility devoted to end-of-life care.”
End-of-Life Care: Questions and Answers | The National Cancer Institute
End-of-Life Care Resources | Hospice Foundation of America
Quality of Life at the End of Life: A Guide to Hospice and Palliative care at Home | HelpGuide.org