From the Guidelines
Transferring a terminally ill patient to a hospice house can be appropriate despite the risk of death en route, as it provides access to specialized care that prioritizes the patient's comfort, dignity, and quality of life. When considering transfer, the medical team should assess the patient's stability, their expressed wishes, and the potential benefits of hospice care 1. The decision to transfer should be based on a comprehensive evaluation of the patient's condition, including their physical, emotional, and social needs.
Before transfer, the medical team should stabilize the patient as much as possible, administer appropriate comfort medications such as morphine for pain (typically 2-5mg IV/SC as needed), midazolam for anxiety (1-2mg IV/SC), or glycopyrrolate for secretions (0.2-0.4mg SC/IV) 1. The transport team should include healthcare professionals trained in end-of-life care and equipped with necessary medications and equipment. Family members should be fully informed about the risks, including the possibility of death during transport, and appropriate consent obtained.
The receiving hospice should be notified about the patient's condition to ensure seamless care transition. This approach balances the risk of transport against the benefits of specialized hospice care, which includes comprehensive symptom management, emotional support, and a peaceful environment for the patient's final days. According to the European Society of Cardiology Heart Failure Association position paper, integrating a palliative approach into heart failure care can improve the quality of life for patients with advanced heart failure 1. Similarly, the American Thoracic Society clinical policy statement emphasizes the importance of palliative care for patients with respiratory diseases and critical illnesses, highlighting the need for comprehensive symptom management and emotional support 1.
Key considerations for transferring a terminally ill patient to a hospice house include:
- Assessing the patient's stability and potential benefits of hospice care
- Administering comfort medications as needed
- Ensuring the transport team is trained in end-of-life care and equipped with necessary medications and equipment
- Informing family members about the risks and obtaining appropriate consent
- Notifying the receiving hospice about the patient's condition to ensure seamless care transition.
From the Research
Transferring a Terminally Ill Patient to a Hospice House
- The decision to transfer a terminally ill patient to a hospice house is complex and involves various considerations, including the patient's quality of life, care needs, and preferences 2, 3.
- Studies have shown that transferring patients from hospital or hospice to care homes for end-of-life care can be a source of anxiety and distress for patients, relatives, and healthcare professionals 4, 3.
- The possibility of death en route to a hospice house is a significant concern, and healthcare professionals must weigh the potential benefits of transfer against the risks and uncertainties involved 5, 3.
- Research suggests that clear communication with patients and their families, as well as a consistent process for decision-making, are essential in reducing distress associated with transfers 4, 3.
- The quality of palliative care in hospice houses and care homes is also an important consideration, as it may vary and impact the patient's experience and outcomes 4, 3.
- Ultimately, the decision to transfer a terminally ill patient to a hospice house should be based on individual patient needs and preferences, taking into account the potential benefits and risks of transfer, as well as the availability and quality of care in the receiving facility 2, 5, 3.