From the Guidelines
Hospice care is a specialized form of medical care focused on providing comfort and support to patients with terminal illnesses who have a life expectancy of six months or less, and I strongly recommend considering hospice when curative treatments are no longer effective or desired. Hospice services typically include pain management, emotional support, and practical assistance, provided by a multidisciplinary team including doctors, nurses, social workers, chaplains, and volunteers. According to the American Heart Association, hospice care is defined as the support and care for patients and their families in the last phase of an incurable disease so that they may live as fully and comfortably as possible 1. The goal of hospice care is to achieve the best quality of life for patients and their families by preventing and relieving pain and other distressful physical, psychological, social, and spiritual symptoms 1.
Hospice care can be provided in multiple settings, dependent on the patient’s and family’s needs and preferences, including at home, in nursing facilities, or dedicated hospice centers 1. Medicare, Medicaid, and most private insurances cover hospice care completely. The focus of hospice care shifts from curing the disease to maximizing quality of life, managing symptoms, and providing emotional and spiritual support for both the patient and family. This approach acknowledges death as a natural process while ensuring patients live their remaining time with dignity and minimal suffering.
Some key aspects of hospice care include:
- Pain management with medications like morphine, hydromorphone, or fentanyl for severe pain
- Emotional support and counseling services, including bereavement counseling for the terminally ill patient, and adjustment-to-death support for the patient’s family and friends
- Practical assistance, such as help with daily activities and household chores
- Spiritual support, such as clergy visits and spiritual counseling
- Access to medical supplies and equipment, such as oxygen tanks and wheelchairs.
It is essential to note that hospice care is not just for cancer patients, but also for patients with other terminal illnesses, such as advanced lung disease, heart disease, and neurological disorders 1. The criteria for eligibility for hospice care include a prognosis of six months or less, as certified by a physician, and the patient’s agreement to forgo curative treatments 1.
In summary, hospice care is a vital component of healthcare that provides comfort, support, and dignity to patients with terminal illnesses and their families, and I strongly recommend considering hospice care when curative treatments are no longer effective or desired, as supported by the American Heart Association 1 and the American Thoracic Society 1.
From the Research
Definition and Purpose of Hospice Care
- Hospice care is a type of care provided to patients who are terminally ill and have a limited life expectancy, typically six months or less 2.
- The primary goal of hospice care is to provide comfort, relief, and support to patients and their families, rather than to cure the underlying illness.
Medications and Symptom Management
- Commonly prescribed medications in hospice care include opioid and nonopioid analgesics, anxiolytics, anticholinergics, and antipsychotics 3.
- Sustained-release opioid preparations, such as morphine, oxycodone, and transdermal fentanyl, are often used to manage pain in hospice patients 4.
- The choice of medication and dosage depends on the individual patient's needs and medical condition.
Prognostic Factors and Life Expectancy
- Several factors can influence life expectancy in hospice patients, including performance status, requirement for admission, elevated serum bilirubin, and hypotension 5.
- Accurate prediction of life expectancy is important for medical and social reasons, but can be challenging.
Advance Care Planning and Hospice Services
- Advance care planning, including advance directives and physician orders for life-sustaining treatment, is essential for patients with severe chronic or terminal conditions 2.
- Hospice services can provide significant benefits to patients and their families, including improved symptom management, emotional support, and increased satisfaction with care 2.
- Despite these benefits, many patients do not use hospice services, and physicians should encourage their use for patients with a limited life expectancy.
Challenges and Considerations
- The opioid crisis poses a significant challenge for hospice care, as opioids are often necessary for pain management, but can also contribute to substance use disorders 6.
- Hospice programs should develop standardized policies and guidelines for managing pain and substance use disorders in patients with active or at-risk substance use disorders.