HOW DO I TALK TO A PATIENT AND FAMILY ABOUT HOPSICE CARE?

All too often families tell us “We wish we had known about hospice sooner”. We realize how difficult it is to discuss end-of-life issues with your patients and their families. The tips below have been developed with respect for the physician-patient relationship and understanding that each situation and patient is unique. 

~ Identify other decision makers: most people don’t make end of life decisions alone. ~

Who do you rely on to help you make important decisions?

Who in the family should be with us when we discuss results?

 

~Provide your patients, their families, caregivers and others involved in the decision making process with the information they need to make decisions. Provide a clear overview of the diagnosis, prognosis, treatment options, risks, benefits and outcomes.  Assess understanding of prognosis; identify gaps in patient’s knowledge.~

What do you understand about your condition?

 Do you think you will get better, worse, or stay the same over the next few months?

  In the next few weeks, there will be some choices that you’ll need to      
        make, and I’m here to help you make them.

Provide general estimates of how long a patient will survive and how
his or her condition will progress.

 

~ Discuss goals for care for the patient and for family members.~

               What do you hope for most over the next few months?

  What are your fears?

 Are there things you need or want to do?

 

~ Reframe goals, admit limitations.~

               I wish we could guarantee….but unfortunately we can’t. 

Perhaps we can …. instead.

 

~ Identify needs for care.~

It can be difficult to care for a family member at home; no one can do
it alone. Have you thought about what kinds of help you might need?

             Would it help if we could send a nurse to your home to check on you?

Are there any financial, emotional, spiritual issues you would like help with?

 

~¨ Summarize and link goals of care needs.~

              It sounds like you main goal is to stay home and be with your family
and remain in control of your care.

 I can tell that you want to be as independent as possible and not be a
burden to your family. We can have a nurse visit at home and having
some help around the house might make that possible.

 

~Introduce Hospice as a way to achieve goals and meet needs.~

One of the best ways to give you the help you will need to stay at
home with your family is hospice. Have you heard of hospice?

 Hospice is able to provide more services and support at home than
most other home care programs. The hospice team has a lot of
experience caring for seriously ill patients at home.

  Hospice helps people die naturally in their own time and helps people
live as well as they can for a long as they can.

 

~Respond to emotions, reaffirm your role, recommend hospice, provide closure.~

I can see it’s not easy for you to talk about this. Tell me what’s
upsetting you the most.

I usually recommend that hospice get involved for patients at this
stage of their illness.

 I will continue to be your physician while you are with hospice and will
work with the hospice team to ensure you remain pain free and comfortable.

 I think hospice would be your best choice right now, but of course the
final decision is yours. Think it over for a day of two.

               You know I will continue to care for you whatever decision you make.

If you want, I can arrange for a hospice team member to visit you so
you can decide for yourself whether hospice is right for you.

 HOW CAN HIGH DESERT HOSPICE HELP YOU IN CARING FOR YOUR PATIENT?

Regular visits by our interdisciplinary team to address all the patient and family’s needs.

Symptom management without crisis.

On-call nurse available 24/7.

Timely updates and handling of most patient calls, increasing flexibility in your schedule.

 

OUR ONLINE RESOURCES FOR CLINICIANS

 

 American Academy of Hospice and Palliative Medicine (AAHPM)
http://www.aahpm.org/

AAHPM is an organization of physicians and other medical professionals dedicated to excellence in palliative medicine, the prevention and relief of suffering among patients and families by providing education and clinical practice standards, fostering research, facilitating personal and professional development of its members, and by public policy advocacy.

Center to Advance Palliative Care
http://www.capc.org/

The Center to Advance Palliative Care (CAPC) is dedicated to increasing the availability of quality palliative care services in hospitals and other health care settings for people with life-threatening illnesses, their families, and caregivers.

Fast Facts Index
http://www.eperc.mcw.edu/ff_index.htm

Fast Facts are peer reviewed, one-page outlines of key information on important end-of-life clinical topics for end-of-life educators and clinicians.

Education on Palliative and End-Of-Life Care (EPEC)
http://www.epec.net/EPEC/webpages/index.cfm

The mission of the EPEC project is to educate all healthcare professionals on the essential clinical competencies in palliative care.

End of Life Nursing Education Consortium
http://www.aacn.nche.edu/elnec/

The End of Life Nursing Education Consortium is part of American Association of Colleges for Nursing, focusing on palliative and hospice care.