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Physicians and Nurses are naturally uncomfortable discussing Hospice Care with patients and families.  This is due, in part, to the fact that almost all of our professional training and focus of our professional careers is focused on the hope and assumption that we can treat or cure disease.  However, when armed with the facts about what Hospice is (and what it isn’t) most clinicians can be a patient’s best advocate when confronting this delicate discussion.  This tool is designed to assist clinicians in doing just that.  We must frame Hospice care as supportive and palliative, and respect the wishes of our patients and families as they transition from aggressive treatment to supportive care.  Overall, the following suggests ways this may be accomplished.

On our website, you can see FAQ’s and other links that dispel the myths associated with Hospice.  Reviewing and understanding this information is a key component to obtaining an all-around knowledge base in preparation for clinical scenarios that WILL come up in your practice.  If you have spent years memorizing, preparing, understanding, and practicing your craft, to fully complete your knowledge base and function as the best patient and family advocate as possible, you would be well served to familiarize yourself with certain aspects of Hospice and be prepared to discuss this with families.  No one but Hospice employees are expected to know the answer to every question possible, so feel free to utilize Virginia’s Hospice’s team for lengthy, in depth discussions.

If possible, the minimum discussion should be that:
a) Hospice is not accurately understood outside of the Hospice community
b) Hospice provides services available in no other industry
c) that a “Hospice Consult” from a Medicare Certified Hospice Company can answer any question that patients and families may bring up

This table represents the appropriate steps to initiate the Hospice conversation:

1. Establish an appropriate setting for the discussion.

a)     Private setting
b)     Allow time for discussion
c)     All possible members present
d)     Multiple levels of licensure present where possible

2. Ask the patient and family what they understand.

a)     Dispel any myths associated with Hospice (link)
b)     Explain that Hospice is supportive, palliative, and multidisciplinary
c)     Hospice is NOT giving up hope
d)     Hospice is NOT for the last few days or weeks of life

3. Find out what they expect will happen.

a)     Explain in detail the medical prognosis
b)     Use terms like “usual course” when referring to life expectancy

4. Discuss overall goals and how hospice will help achieve them.

a)     Management of pain, anxiety, spiritual issues
b)     Preferred setting for receiving services

5. Respond to emotions.

a)     Any feelings that patients and families could have regarding Hospice are normal.  Allow for full expression of those feelings, reinforce that it is a normal part of the process.
b)     Be mindful that if patients and families know “all about Hospice” that they may only have been exposed to a limited interaction.  Each patient/family experience is unique.

6. Establish and implement the plan.

a)     Explain to patient and families that a reputable Hospice company will contact them and explain everything from Medicare Benefit perspective.  Feel free to refer them to our website for further information.
b)     Call Virginia’s Hospice, explain nature of case.  We will contact and discuss, then reach out to you with a “plan” for the patient/family.