COMPASSIONATE CONVERSATIONS AND CONNECTIONS TO HOSPICE

Although it may feel like there aren’t any options left when a patient is in the last stages of life, there is an option that can convey support in a caring way. Having conversations with patients and families about the final stages of their life can be one of the more difficult tasks for physicians.  As a physician you can begin these conversations in a compassionate way that will also provide a caring connection to Hospice by asking the patient and family:

“What is important to you at this time in your life?  What are your hopes, desires and dreams?”

Once they respond you can then offer hope and support by saying;

“I understand from other patients and families that when they hear this news they have many questions, concerns and perhaps some fears about what to expect during this time and how to manage as a family.” 

“I want you to know I will still be here to support you through this stage of your disease.”

“We cannot cure your disease, but we can work together to keep you comfortable, focus on your goals, honor your wishes, and support a good quality of life.”

 “There is a service in our community called Hospice care that I collaborate with to help patients and families during this time that I believe would help you meet your goals. Their skilled team of professionals and volunteers work with me to assure that you will be comfortable and have the support you need to meet your unique needs and help your family. Can I ask them to come and talk with you to explain their services further?”

“If you are not sure, you can decide if you want their help after you talk with them. I would like to ask them to come and talk with you. Is that OK?”

Another caring approach is to have a conversation about their choices before the time of crisis or before your patient’s condition progresses to the final stages. Ask if they have a living will or have had conversations with their family about their wishes. If one is completed, you may wish to review it with the patient, family, and/or healthcare surrogate to be sure everyone is aware of the patient’s wishes. If one is not completed this may be something you can offer in consultation with the patient. This may also be a way to begin conversations about end-of-life before the time of crisis. You may want to approach this conversation as follows:

“You have had (heart) disease for some time now and as you know it is not something that we can cure but we can and will continue to manage your symptoms and provide as much support as possible. But I’d like to talk about the future before the time of a health crisis and give you some time to think about some things and make some decisions.”

“There will come a time when your disease progresses and you may be faced with some decisions about what type of care you want or don’t want. It is important to think about these possibilities before a crisis and to let your family know your wishes. One of the hardest things we face with families is when they have to make decisions about someone else’s care when they have never communicated their wishes. This could be a gift to your family.” 

“ Do you have any type of written documents about your health care wishes? A Living Will? Healthcare Power of Attorney?” 

“Do you have a health care decision maker identified if you can not communicate your own wishes?”

“We have these packets of information in our office and I would like to give you one to take home to discuss with your family. An Advance Care Plan includes your designation of your health care surrogate and an alternate and your personal wishes regarding how you want to be treated as you approach end-of-life. If you choose to complete these documents, please send a copy to me for my records so I too know what your choices are about your care.”(1)

In summary, physicians should realize that recommending Hospice services can greatly extend their scope and effectiveness of end-of-life care; that Hospice care may be beneficial to patients of all diagnoses coping with end-of-life issues; and that early referral out to a year of expected time of death is likely to result in much greater patient and family benefit. Referral to Hospice can be introduced with appropriate dialogue that can be comforting and supportive to patients and family, with reassurance that the individual’s personal needs and wishes will be of primary concern through their last journey of life.

^[1] Emanuel, L.L.; von-Gutten, C.F.; & Ferris, F.D. Education for physicians on end-of-life-care: Trainers guide. The Robert Wood Johnson Foundation. 1999.

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