Hospice

1. The Grief and Mourning Quiz

Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Hospice is a service, not a physical place.
• Hospice does not hasten or prolong death.
• Hospice may be recommended for patients in the late stages of a terminal illness.
• The goal of hospice is to provide comfort, reduce suffering, and preserve patient dignity.
• A team consisting of doctors, nurses, social workers, clerics, volunteers, and therapists participate in the care of hospice patients.
• Medicare, Medicaid, and most private insurance carriers provide hospice benefits.

Hospice is a field of medicine that focuses on the comprehensive care of patients with terminal illnesses. Hospice is not a place but rather a service that offers support, resources, and assistance to terminally ill patients and their families.

The main goal of hospice is to provide a peaceful, symptom-free, and dignified transition to death for patients whose diseases are advanced beyond a cure. The hope for a cure shifts to hope for a life free of suffering. The focus becomes quality of life rather than its length.

Hospice care is patient-centered medical care. A host of valuable services are offered to address every aspect of the patient's care as a whole. This is achieved by considering each individual's goals, values, beliefs, and rituals.

In many chronic and progressive conditions such as cancer, heart disease, or dementia, the natural disease process can ultimately reach an end stage. Most of the time, as a disease progresses to an advanced stage, its symptoms become more intolerable and difficult to control. As a result, an end-stage condition can significantly impair a person's functional status and quality of life.

At this point, often there is no further cure or treatment to control the progression of the disease. Furthermore, aggressive treatment may only offer little benefit while posing significant risk and jeopardizing the patient's quality of life.

In such late stages of diseases, especially when there is "nothing left to do," hospice can offer help for patients and families. There are many aspects of a patient's well-being that can be addressed. Hospice can play a key role in managing physical symptoms of a disease (palliative care) and supporting patients and families emotionally and spiritually.

Hospice care promotes open discussions about "the big picture" with patients and their loved ones. The disease process, prognosis, and realities are often important parts of these discussions. More importantly, the patient's wishes, values, and beliefs are taken into account and become the cornerstone of the hospice plan of care.

Hospice and palliative-care philosophy encourages these type of discussions with treating physicians early on in the course of a terminal disease. Patients can outline their preferences before they become too ill and incapable, thereby relieving some of the decision-making burden from family members.