Explaining hospice care to a patient’s family can often be a difficult task for a physician. Although end-of-life care may be challenging to discuss, having these discussions well in advance can make hospice easier to manage and understand for all who are involved.
At West Virginia Caring, we often hear the regrets from our patients and families, acknowledging they should have received hospice service sooner because of the excellent care and additional support they received. During a life-limiting illness, and especially before a medical crisis, it is important to discuss all healthcare options with your patients, including hospice. Even though some physicians are hesitant to talk about hospice, many patients become grateful and relieved to have their physicians initiate that conversation and develop a plan of care that focuses on their goals.
Know When Hospice Care is Appropriate
Hospice care may be appropriate for any patient with end-stage illness (such as cancer, pulmonary disease, Alzheimer’s and other non-malignant conditions.) Prognoses are not always certain, as some terminal illnesses have unpredictable courses.
However, if you believe your patient has six months or less to live, you can certify your patient with West Virginia Caring. You and our hospice team will develop a care plan that includes the patient and the family’s desires. If your patient is enrolled with WV Caring and lives beyond six months, our staff will make a face-to-face visit with your patient to confirm our care, recertifying as appropriate.
Understand Your Role as a Physician
You play an essential role in providing your patient’s choices for end-of-life care. Hospice supports you, the physician, by enhancing and extending your attention, which results in reduced hospitalizations and ER visits and, most importantly, the best quality of life for your patients and their loved ones.
You identify the need for end-of-life care and communicate that need to the patient and loved ones. It would be best to let the patient know that you will continue to see and care for them. Additionally, WV Caring can assist any healthcare professional when they discuss hospice with their patient if needed.
When your patient elects their Medicare Hospice Benefit, they designate an attending physician. Based on your clinical expertise, you will be certifying that the patient has a prognosis of six months or less should their illness run its natural course. With this initial hospice election, the hospice must obtain the terminal illness certification from the patient’s attending physician, if there is one, and the hospice medical director. It’s important to know that the patient can choose their attending physician, or not to have one. It is not required to have an attending physician.
Get Comfortable Discussing Hospice With Patients
American Medical News details these strategies for approaching timely and effective hospice care discussions:
- Identify other decision-makers. “Who in the family should be there with us when we discuss the results?”
- Assess understanding of prognosis. “What have other doctors told you about your condition? … From what you know, do you think that over the next month, your condition will get better or worse or stay the same?”
- Define the patient’s goals for care. “What do you hope for most in the next few months? … Is there anything you’re afraid of?”
- Reframe goals. “I wish we could guarantee that we could keep you alive until your daughter’s graduation, but unfortunately, we can’t. Perhaps we can work together on a letter for her to read on that day, so she will know you are there in spirit if you cannot be there.”
- Identify the needs for care. “It can be very challenging to care for a family member at home, and no one can do it alone. Have you thought about what kinds of help you might need?”
- Summarize and link goals with care needs. “So I think I understand that your main goal is to stay at home and spend time with your family. To do that, we will need to help you in several ways, for instance, by sending a nurse out to your home and giving you both some help around the house. Is that right?”
- Introduce hospice. “One of the best ways to give you the help you will need to stay at home with your family is a hospice program. Have you heard of hospice? Hospice can provide more services and support at home than most other home-care programs, and the hospice team has a lot of experience caring for seriously ill patients at home.”
- Acknowledge the emotional response. “You seemed surprised to learn how sick you are. … I can see it’s not easy for you to talk about hospice.”
- Legitimize reaction. “Many people are understandably upset when they learn how ill their loved one is and that hospice is a possibility.”
- Empathize. “I can imagine how hard this is for both of you; you care about each other so much.”
- Explore concerns. “Tell me what’s upsetting you the most.”
- Explain hospice goals. “Hospice doesn’t help people die more quickly; it helps people die naturally, in their own time.”
- Reassure. “Hospice’s goal is to improve your quality of life as much as possible and help you and your family make the most of the time you have left.”
- Reinforce commitment to care. “Let’s think this over for a day or two; you know I will continue to care for you whatever decision you make.”
- Recommend hospice. “Hospice could be beneficial to you in the ways that we’ve talked about, but I realize it’s a big decision. I’d like to arrange for a hospice nurse to visit you so you can decide whether hospice is right for you.”
Dispel the Misconceptions That Surround End-of-Life Care
Many misconceptions surround the dialogue concerning end-of-life care. Malene Davis, MBA, MSN, RN, Chief Visionary Officer and Founding President of WV Caring, a nationally recognized health care authority on advanced illness, is working to dispel perceptions that hospice and palliative care is only meant for the final few days of life.
“Sadly, most Americans receive too little care, too late to make a difference in their quality of life during their final days,” said Davis. “The best results occur when the patient receives hospice care for three to six months before they pass on. Most patients receive only 18 days of hospice care on average.”
Davis cited a well-known study comparing hospice with non-hospice patients from the Medicare data set. They found for certain diagnoses including congestive heart failure, lung cancer, pancreatic cancer and colon cancer; life expectancy is longer for those receiving hospice care compared to patients who did not receive hospice care. The study, published in the Journal of Pain and Management, found that on average hospice patients lived one month longer than those who did not receive hospice care.
“First and foremost, hospice is not a place where one goes to die,” explained Davis. “Hospice is about living your remaining days with advanced illness as fully as possible, with less pain, more comfort and surrounded by loved ones,” she continued.
Hospice care is fully covered by Medicare, Medicaid, and most private insurance plans and HMOs. Surprisingly, only 10% of hospice-eligible patients are using this concierge service. Despite the low figures, research shows that hospice usage in the US is growing. Every year, between 1.4 and 1.5 million Americans are cared for by a hospice provider for at least one day. However, probably close to 17 million patients are eligible for the service, but are not using it.
She continued, “Earlier use of hospice equates to demonstrably superior end-of-life experiences for patients and their families.”
At WV Caring, we realize that the earlier that you can recommend hospice care, the sooner we can help your patients find a quality of life that they are comfortable with. This includes: increased improvement outcomes, decreased visits to the emergency room and hospital readmissions and better patient and family outcomes. We have a proven track record to manage your patient’s pain and other symptoms of their disease at home or wherever they call home.
If you have held off on starting the end-of-life care conversation with your patients, remember the time is now. At WV Caring, we believe that talking about what the patient wants at the end of their life with their loved ones and care team is important. Talking through their wishes can give everyone a shared understanding of what matters most to them, such as: healthcare treatments in the event of a medical crisis and choice about their quality of life. If you would like more information about how WV Caring can help you, contact our Access Center at 1-866-656-9790.
How to talk about hospice care – amednews.com