Back in June, I read an article about a study published in The Journal of Oncology Practice. Essentially, the study looked at a random sample of 390 patients from Maryland who died from cancer between 2004 and 2008. The mean age at death was 70 years; 52% of patients were male; and 34% died of lung cancer. Median survival from diagnosis to death was 8.4 months with hospice and 5.8 months without hospice. No surprise to me.
As with many studies comparing patients who’ve used hospice to those who have not, the data clearly shows the benefit to both patients and families who involve hospice earlier vs. later, or not at all. The more time patients and families have to participate in the hospice experience, the better the outcomes and the lower the overall cost of care for both patient and family (perhaps by preventing subsequent mental health issues caused by not having an opportunity to properly grieve).
While the studies show the clear value and benefits of hospice care, the decision to enter into hospice care is not always an easy thing to discuss with a loved one who has a terminal illness. Dr. David Cowall, one of the study’s authors, talks about his experiences with this issue in the article. Because he is sometimes faced with patients who get angry with him, and in some cases seek another physician, he always takes a thoughtful and measured approach to raising the subject of hospice with his patients.
Based on his experiences, I’ve compiled some helpful things to consider when thinking about having the Hospice Conversation:
- The earlier the conversation takes place the better. Talk with your loved one’s physician if they don’t bring it up first. Don’t feel bad about bringing it up…you’re actually enabling your loved one to speak openly about what has almost certainly crossed their mind.
- Involve multiple family members in the conversation. This is one of those times when strength in numbers may make a difference.
- Remember that the patient is the ultimate decision maker and that your job is to help them explore their options. Don’t force a decision…be empathic, supportive, and patient.
- Focus the conversation around high quality end-of-life care and stress the emphasis on a holistic approach that involves the entire family. In addition, make it clear that in hospice, the emphasis is on symptom management and pain control.
- Finally, stress that hospice isn’t about dying…it’s about living with peace of mind and comfort while making the most of the time left.
Of course, every situation is different, and none of these situations are easy. That’s two things they all have in common.
For a FREE copy of Hospice Care Conversation Starters: A Guide to Introducing Hospice by Gail E. Neben, click here. We’re happy to send you a copy, or you can download it from our website.