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Having the Difficult Conversation: Referring a Patient to Hospice
The most difficult conversation a physician may have with her patient is one that includes the word “hospice.” But it also may be the most compassionate one, said Dr. Christine Marsick, Visiting Nurse Association of Ohio Hospice.
Physicians recommend hospice care for patients who have reached the extreme end of their diseases – cancer, heart disease, a lung disorder or any other terminal condition.
According to Medicare guidelines, hospice care is available to a patient with a life expectancy of six months or less, as agreed upon by two physicians. Of course, no one really knows how long a person has to live, said Marsick. So a referral to hospice isn’t an indication of how much time a person has left as much as it is an acknowledgement that the treatment to prolong his life is no longer working.
“It isn’t that the doctor or the hospital isn’t trying,” Marsick said. “It’s just that all the kings horses and all the kings men can’t really fix the problem. Sometimes the best care might be to make the patient comfortable at home.”
Hospice care does not cure the patient’s condition or even to prolong life, Marsick said. The aim, instead, is to make the time the patient has left as comfortable and pleasurable as possible.
How Hospice Helps
That often involves managing the patient’s pain level, but it also can mean prescribing medications for anxiety, addressing breathing problems or providing therapeutic massage for pain control, symptom reduction and general relaxation. VNA of Ohio Hospice homecare professionals help their patients identify goals, and then they do what they can to help them achieve those goals.
If, for example, a patient wants to attend a family reunion, VNA of Ohio Hospice team might work on getting her nausea under control and make arrangements for her to travel more comfortably. A patient struggling to stay awake during visits with his family might change to a medication where he can stay alert during the day.
“When someone decides on hospice, in their heart they feel at peace that they will not be going back to the hospital. They won’t be going for x-rays or to the cath lab if they have chest pain,” Marsick said. “They know the focus is on giving them the best quality of life.”
Educate Yourself About Hospice
She said the decision to choose hospice isn’t always easy. Patients sometimes cannot face their prognosis and want to continue fighting. Other patients tire from a treatment they wish to stop, but the family can’t accept this decision. Some physicians themselves are reluctant to stop treatment, particularly if the patient decides to stop mid-course. Sometimes, primary care doctors may realize their patients don’t have long, but they don’t want to have the tough conversations.
For all of these reasons, patients are denied the most valuable benefits of hospice care, Marsick said. That’s why it’s important that patients be educated about hospice and that they indicate their wishes before they have to make the decision. VNA of Ohio’s special care nurses can work with physicians to help facilitate that conversation.
“It can be a help to the doctor to have our special care nurses participate in the hard work of teaching people about hospice,” Marsick said. “At the first cue from the doctor, we can start talking to the family, so it isn’t such a scary thing.”
Contact VNA of Ohio Today
Learn more about VNA of Ohio hospice services or call us today at 1-877-698-6264.