How To Provide Better End of Life Care - Improving the Hospice Care Experience

Doctors and their staff need to learn about how to discuss hospice care with their end stage patients.  Medical and nursing schools do not provide any education about how to drive a positive conversation about hospice with a patient as they enter the final part of their life.   

I have learned from my many experiences that there are patterns of conversations a clinical staff can have with their patients that lead to positive and life changing experiences as a person enters into hospice care. 

Medical caregivers who are able to help their patients explore four basic important points can make a huge difference in the final days and weeks of a patient in hospice care. They need to guide their patients and help them to understand and share:

(1) What is their understanding of their current health or condition and what is their understanding of their near future health or condition.

(2) If their health continues to decline, what are their realistic personal goals and priorities for the near term?   

(3) What are their fears?

(4) What are the trade-offs they are willing to make and not willing to make as their health declines?

It is important to remember that these answers change over time, so the conversation about these four concerns needs to be repeated on a regular basis. 

The clinical team needs to ensure that, as much as is realistic, these goals are respected and be the driving force behind the delivery of the hospice services.  Both the clinical team and the rest of the people in the patient’s life should know and respect these needs and goals. The patient must also know that they will be respected.

The over riding goal of hospice care is to give each individual person their best possible day as they define it.  Although not as granular as the four prior points, if a hospice nurse first comes to a patient and asks what the patient cared most about in their life, what having the best day possible meant and then worked together with the patient to make it happen that day, hospice would be wildly successful. 

Joel T. Nowak, MA, MSW wrote this Post.  Joel is the CEO/Executive Director of Cancer ABCs.  He is a Cancer Thriver diagnosed with 5 primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma and a rare cancer, Appendiceal Cancer.