hospice care and terminal illness

Death with Dignity: You Have to Ask for It

Study: Many doctors don’t talk to terminally ill patients about hospice care, even though it eases the burden for patients and their families.

Death with Dignity: You Have to Ask for It

Hospice care provides medical and social support to patients living at home.

RODALE NEWS, EMMAUS, PA—Hospice care, a service that can help people with terminal illnesses live at home, isn’t getting as much attention from physicians as it probably should. A study just published in the Archives of Internal Medicine found that doctors discussed hospice care with only about half of their terminally ill patients. Hospices offer services to help keep patients comfortable well in advance of their final days, usually in their own home, with improved quality of life and symptom management. But some physicians and patients may avoid the topic, because “people often think death will occur right away. They think it means giving up,” explains study coauthor Haiden A. Huskamp, PhD, associate professor of health care policy at Harvard Medical School in Boston. In reality, many people in hospice live longer than expected.

THE DETAILS: Researchers used data on 1,517 patients diagnosed as having stage IV lung cancer, a condition known to have a poor prognosis. Despite this fact, only half of the patients said their healthcare providers discussed hospice options with them. Discussions regarding hospice were less likely among patients who were black, Hispanic, non-English speaking, married or living with a partner, lower-income Medicaid beneficiaries, or had undergone chemotherapy. The study authors conclude that improved communication between doctors and patients could help patients better understand hospice and its role in their prognosis.

WHAT IT MEANS: While the study focused on patients with advanced lung cancer, Huskamp says she believes the lack of communication between doctors and patients with limited life expectancies is a broader issue. “Having these conversations is really hard. It’s hard for the patients, the families, the doctors,” says Huskamp. “And there are many reasons why doctors don’t address hospice. Some may feel they’re not adequately trained to talk about it, others want to give hope as long as possible, and some try to exhaust all life-extending processes first.”

Huskamp notes that hospice is a different healthcare service than most, in that providers don’t just focus on alleviating pain, but include counseling to the patient and family members. “The package of services typically includes social workers, spiritual counseling—people who can talk with you about how you’re approaching death, help you prepare for it,” Huskamp explains. “Family is very involved in a typical hospice situation, and bereavement counseling is usually available after a patient dies.”

Here’s how to find out more about hospice, and if it’s right for you or a loved one:


Published on: May 29, 2009

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