Palliative care teams can help patients transition to hospice care in a more seamless, timely way that can bring increased quality of life and peace of mind. The foundation for that transition, however, is often set long before.
Demonstrating compassion and a commitment to honoring patients goals and wishes is key for these teams as they prepare themselves and families for hospice conversations, according to Dr. Diane Meier, founder, director emerita and strategic medical advisor of the Center to Advance Palliative Care (CAPC).
“Before invoking hospice, palliative care teams need to signal that they care about the patient and their family, understand what matters most to them, and value their input,” explains Meier told Palliative Care News. “Then, when hospice is brought up, the team has already built a trusting relationship in which they can candidly discuss topics like what the patient and their family may already know about hospice, how the patient is responding to treatment, how choosing hospice can affect insurance coverage, and that the patient can come off hospice at any time.”
In addition, according to Skelly Wingard, CEO at By the Bay Health, effective palliative care teams also understand that one size doesn’t fit all.
“Sometimes, patients and their families are very interested in hearing about hospice, while others want it brought up slowly,” Wingard said, “Also, when the patients don’t have advocates or family members, we can become like their extended family, keeping them informed, supporting their decision-making and emphasizing that transitioning to hospice is fully their choice.”
As these conversations continue, palliative care teams also listen closely to ensure understanding of what’s being said, what’s available and the consequences of making different choices. The conversations also provide a platform for addressing advance care planning topics that can make the transition go smoother, and when the patient becomes eligible, happen sooner.
“With advance care conversations, palliative care teams help patients reflect on and communicate their values, life goals, expectations around future care, and more,” Wingard said. “You do not want to be first having these complex conversations when the patient is in crisis, though, which could affect the quality of the decision-making. The earlier they’re started, the better.”
One barrier is that many clinicians outside of the hospice and palliative care space are not experienced or trained to carry out goals-of-care conversations, according to Meier. Another factor is a culture of widespread discomfort with discussing death and dying.
“The vast majority of physicians don’t get trained or have practice in having advanced care conversations,” Meier said. “Also, primary care teams, in general, are often overwhelmed and don’t have the opportunity to practice them. Contributing to this delay, too, is that death is not a popular topic in our society.”
As palliative care teams build these trusting and informative relationships, they also can facilitate earlier admissions to hospice when patients become eligible, Wingard indicated.
“The care teams can identify patients with serious illness who may benefit from hospice sooner,” Wingard said, “This allows the patient to benefit from hospice services for a longer period and potentially experience improved quality of life and symptom management.”
In all, effective transitions to hospice can be meaningful not only to patients and their families, but also to the providers themselves, according to Meier.
“So much of human suffering is preventable and treatable,” Meier told Palliative Care News. “For example, I know very straightforward treatments that can reduce depression, shortness of breath and even itching. If no one is trained in how to do that, they can feel hopeless and helpless. And that means the patients and families may feel that way, too. These are solvable problems. It’s just a matter of having the commitment, will and determination.”
