What is the appropriate cause of death to list on a death certificate for a patient on hospice (Hospice Care)?

Appropriate Cause of Death on Death Certificates for Hospice Patients

The appropriate cause of death on a death certificate for a hospice patient should be the underlying terminal disease that led to hospice enrollment, not "hospice" itself, as hospice is a care setting and not a medical cause of death. 1

Understanding Death Certificate Completion for Hospice Patients

When completing a death certificate for a patient who dies while receiving hospice care, physicians should follow these guidelines:

1. Identify the underlying cause of death: This is the disease or condition that initiated the chain of events leading to death. For hospice patients, this is typically the terminal diagnosis that qualified them for hospice care, such as:

   • Advanced cancer
   • End-stage COPD
   • Advanced heart failure
   • End-stage neurodegenerative disease
   • Advanced cirrhosis
   • End-stage renal disease

2. Document the sequential chain of events: List conditions in order from the immediate cause of death (final disease or condition resulting in death) back to the underlying cause that started the sequence.

3. Avoid listing "hospice" as a cause: Hospice is a care delivery model, not a medical condition that can cause death 2, 1.

Common Pitfalls to Avoid

• Do not list "hospice" or "palliative care" as a cause of death - these are care approaches, not diseases or conditions
• Do not list mechanisms of death (e.g., cardiac arrest, respiratory failure) as the underlying cause - these are terminal events common to many diseases
• Do not list vague terms like "old age" or "natural causes" without specifying the underlying disease process
• Do not omit the underlying terminal condition that qualified the patient for hospice care

Example of Proper Death Certificate Completion

For a patient with end-stage COPD on hospice:

1. Immediate cause: Respiratory failure
2. Due to: Acute exacerbation of COPD
3. Due to: End-stage chronic obstructive pulmonary disease (underlying cause)

Other significant conditions contributing to death but not resulting in the underlying cause: Cor pulmonale, cachexia

Special Considerations

• For patients with multiple serious conditions, the condition most responsible for the terminal decline should be listed as the underlying cause
• When uncertain about the exact cause, the physician who certified the patient as terminal for hospice eligibility should use the same condition(s) that qualified the patient for hospice 1
• If an autopsy is performed, the death certificate should be amended if findings show a discrepancy with the clinical diagnosis 3

The accuracy of death certificates is crucial as they form the basis of mortality statistics used for public health planning and research 4. Proper completion ensures that the true burden of various diseases is accurately reflected in national health statistics.