How to Discuss Hospice with a Terminally Ill Relative
Introduce hospice early in terminal illness by aligning the patient's and family's stated goals with the specific services hospice provides, using concrete language that connects their fears and needs to hospice solutions. 1
Timing: Start the Conversation Early
Begin discussing hospice and palliative care options early in the course of terminal illness, not waiting until the final weeks or days. 1 Studies show that delaying these conversations until the last month of life—or avoiding them entirely—is a common pitfall that prevents families from accessing beneficial services and increases distress. 1
Recognize that families often need multiple conversations over time as the disease progresses; this is not a one-time discussion. 2
Preparation: Know Your Audience
Determine what the patient and family already understand about the prognosis and whether they recognize that death is approaching. 2 Many families harbor unrealistic expectations about recovery that must be gently addressed before hospice can be meaningfully discussed.
Identify the family's cultural and spiritual context, as some cultures view discussing death as taboo or "airing dirty laundry," while others have strong beliefs about institutional care. 1 Use tools like FICA (Faith and Belief, Importance, Community, Address in Care) to assess spiritual factors that influence decision-making. 1
Assess whether the patient is ready for this discussion by watching for verbal and nonverbal cues. 1 If the patient shows resistance, acknowledge this and offer to revisit the conversation later.
The Conversation Framework: Goals Before Services
First explore the patient's and family's goals, fears, and service needs before introducing hospice as a solution. 1 This prevents the conversation from feeling like you're "giving up" on the patient.
Step 1: Explore Goals and Concerns
Ask open-ended questions: "What are your biggest concerns right now?" "What matters most to you as you think about the time ahead?" "What are you hoping for?" 1, 3
Listen more than you talk—active listening provides powerful support and helps you understand what matters to this specific family. 4, 3
Common concerns include: fear of uncontrolled pain, not wanting to die in the hospital, worry about burdening family, desire to stay at home, fear of being alone. 1
Step 2: Align Goals with Hospice Services
Once you understand their goals, explicitly connect hospice services to those stated needs using concrete, specific language. 1
For example:
- "You mentioned you don't want to spend any more time in the hospital but you're scared about pain control at home. Hospice is a program that can help you stay at home and manage your pain and other symptoms." 1
- "You said being comfortable and spending time with family is most important now. Hospice brings a team to your home—nurses, aides, chaplains—who focus entirely on comfort and supporting your family." 1
Step 3: Explain What Hospice Is and Isn't
Clarify that hospice is not "giving up" but rather shifting the focus from curing the disease to ensuring comfort and quality of life. 1, 5
Explain the interdisciplinary team approach: physicians, nurses, social workers, chaplains, volunteers, and bereavement counselors. 1, 6
Emphasize what will be continued (comfort care, symptom management, family support) not just what will be discontinued. 1
Address Family Members Separately if Needed
Recognize that family members' openness to hospice may differ from the patient's, and address this directly. 1 Some family members may be ready before the patient, or vice versa.
With the patient's permission, include key family members in the discussion, either in person or by phone if they cannot be present. 1
If family members are resistant, explore their specific concerns without judgment. Common fears include feeling they're abandoning their loved one or that hospice will hasten death. 5, 7
Communication Strategies That Work
Use empathy and validate emotions without attempting to "cheer up" the family or minimize their distress. 4, 3 Acknowledge that this is difficult: "I know this is not the conversation you wanted to have."
Avoid medical jargon; use clear, understandable language. 3 Say "hospice" explicitly rather than euphemisms like "comfort care measures."
Be aware of your own discomfort with death discussions and don't let it cause you to tone down or avoid the topic. 1, 8 Research shows that straightforward, empathic discussions about end-of-life issues are more effective than vague or overly optimistic conversations.
Recognize and respond empathically to anticipatory grief—the family is already grieving the impending loss. 1, 4
Provide Concrete Next Steps
Identify and suggest specific local hospice resources, not just the concept of hospice. 1
Offer to arrange a consultation with a hospice team so the family can ask questions without committing. 6
Provide written materials (brochures, pamphlets) about hospice to complement your verbal discussion, as these significantly improve family comprehension and reduce anxiety. 1
Common Pitfalls to Avoid
Never wait until the final days or weeks to introduce hospice. 1 This deprives families of the full benefit of hospice services and increases crisis decision-making.
Don't assume families understand that hospice doesn't hasten death—explicitly state this if needed. 5
Avoid focusing only on what will stop (like chemotherapy) without emphasizing what robust support will be provided. 1
Don't rush the conversation or treat it as a checkbox to complete. 2, 3 Families need time to process and may require multiple discussions.
Never use "at least" statements that minimize the loss or compare their situation to others. 4
Ongoing Support
Establish that you will remain involved and available, scheduling follow-up conversations to reassess and adjust as needed. 2, 4
Refer families to the Alzheimer's Association (if dementia-related), cancer support organizations, or other disease-specific resources in addition to hospice. 2
Offer referrals to psychosocial team members (social workers, counselors, chaplains) when families show signs of complicated anticipatory grief or overwhelming distress. 1