Hospice discussions with seriously ill patients should always take place in the context of their larger goals, using a step-wise approach.
Ensure comfort and privacy; sit down next to them if you can. Ask whether family members may want join before moving forward. Introduce topic: “I’d like talk about the overall goals for your care.”
Assessing Their Understanding
Ask an open-ended questions about their current health situation. It is important to get the patient talking – if the doctor is doing all the talking, it is unlikely that the rest of the conversation will go well. Consider starting with phrases such as: What do you understand about your current health situation? Or, what have the doctors told you about your condition?
You might be surprised at how much you can learn from a patient’s goals for the time they have left. Most people with advanced disease use this opening to voice their thoughts about dying— typically mentioning comfort, family, and home as key points in care that will bring them peace in the time they have remaining.
Introducing Hospice Care
It’s important to summarize the patient’s goals in language they’ll understand when introducing hospice care. Even though some patients or family members may advocate for heroic end-of-life care, there comes a point in everyone’s life where the quality and quantity of life is best achieved in a palliative at-home setting where they can be as independent and comfortable in their final days.
During the first discussion of hospice, patients may have misconceptions about what it means to choose hospice care. Inquire about their previous experiences with a loved one’s demise to learn how they developed their point of view. It may be helpful to detail how hospice will help the patient and their family achieve the goals they’ve described with a team of people that help meet the patient’s and family’s physical, psychological, social, and spiritual needs.
Recommending Hospice Care
Offer your recommendation for hospice by tying it to the goals discussed earlier in your conversation. Normalize your recommendation: I always ask hospice to get involved for my patients at this stage of their illness. When discussing hospice it’s important to reinforce the fact that hospice care is revocable and that they can continue to see their current physicians or visit a hospital.
When a person begins to discuss death, many emotions come up. The acute emotional response is brief and might not as profound for people who have dealt with the passing of loved ones before. It may be helpful to refrain from speaking, provide an empathetic touch, and offer facial tissues.
Creating a Plan
Before exiting, summarize the plan and request that a hospice representative provide information.