Why Didn’t You Refer Your Patient to Hospice?: What Doctors Need to Know Before Avoiding the “H” Word
Many healthcare workers fail to realize that a hospice recommendation does not desert the patient. Despite years of education and experience, doctors still do not know the truth about hospice. While everyone has heard the adage “death is a part of life,” we reject the idea of a terminal illness until it becomes “real.” This common, natural response tends to prolong an unfortunate process to death. All too often, it prevents patients from receiving hospice care in time.
Both professionals and non-professionals hold onto the large misconception of hospice that we serve a patient merely in his or her final three days. In reality, hospice care patients can live 29 days longer than non-hospice patients.
Sherri Bickley, Emotional Support Services Consultant at Crossroads, has no problems addressing the myth. “We don’t wear capes and we don’t carry staffs. We’re not the Grimm Reaper.”
She recommends that doctors bring up hospice as soon as someone presents signs of terminal illness. While doctors should refer to hospices earlier, we would never ask a family or medical professional to give up on a patient. We do ask them to shift their hope. Instead of a focus on curative care, hospice organizations, such as us, focus on comfort care. We help 74.2% of patients reach a comfortable pain level within 48 hours.
Bickley attests to this. “At Crossroads, everything we do is based on quality of life and making sure people are not suffering,” she says. Hospice allows patients to experience a better quality of life. As a woman who lost her mother and whose physician refused hospice, Bickley personally recognizes the importance of Crossroads. “The most prevalent complaint or concern I’ve heard from families is ‘I wish we would have known sooner.’”
That’s why Bickley suggests open discussion with the patient. It places the control back into their hands. After nine years in our Kansas City office and now traveling between all 11 Crossroads offices, she has seen patients “lost in a maze of hospitals and physicians.” Control empowers patients and offers a new type of hope. Hope to die peacefully. Hope to never die alone. Hope for fulfillment. To nurture hope, Bickley advises doctors to set goals with patients. Whether it’s attending a daughter’s wedding in May, reducing pain from an eight to a four on the pain scale, or contacting an estranged son, objectives center the patient’s wishes.
She notes, “It’s kind of with the end in mind, but you focus on things here and now.” Hospice provides patients and doctors a place to concentrate on these last requests. But goals require more time, which is why medical professionals must have the hospice conversation sooner.
The hospice talk is difficult but necessary, and timeliness matters. The sensitive situation might tempt doctors to feel personal failures, but hospice does not equal “quit.” People involved in terminal scenarios view hope as “hope to live.” There is so much more to hope. Hospice care broadens hope to let patients live not in denial or discomfort, but in serenity. Ultimately, physicians can take away three major lessons:
Ask. “Until you know how they define quality of life, you’re not going to be able to help them achieve it.” Try starting questions with “How would you like...?”
Don’t wait. “Patients have the right to choose.” Engage in discussion early. You can call Crossroads 24/7. If you have a patient you think qualifies for hospice, we will meet with the family and perform an evaluation as soon as possible.
Hope. We can all expand our definition. “Hope in living forever is very displaced hope. What we can hope for is the absolute best out of whatever time we have left and hospice will help achieve that.”