Hospice Care: Providing a peaceful passing...
The concept of hospice care has been around at least since the 11th century and relates to the palliation of uncomfortable symptoms and general comforting care in terminally ill patients no matter what the underlying disease. The illness could be cancer, end-stage heart or lung disease, renal failure, Alzheimer’s disease or any other incurable and terminal condition. Usually, hospice care is applied in situations where the projected life expectancy of the patient is around 6 months or less and where all treatment options for curing or arresting the disease have been exhausted or declined.
The idea of hospice care is to provide whatever care and support that might be helpful for a dying patient and the family in order to help alleviate suffering as much as possible. This might be in the form of palliation of physical symptoms such as pain control, prevention of nausea or treatment of shortness of breath. However, it could also be in the form of emotional, psychological or spiritual support.
Often patients and family members are afraid to talk about the illness and/or the dying process. They feel like they are walking on pins and needles and don’t want to raise a subject that might be uncomfortable to talk about or that might make the patient feel bad. Or, they're afraid they will say the wrong thing. As a result, many things that need to be said go unsaid which makes the patient feel alone, and also makes the grieving process for the family more difficult later. Opening communication lines between family members is often helpful in this regard and can be mediated by hospice personnel. Involvement of clergy and/or a psychologist may be beneficial and can be arranged.
Much of the fear of dying is related to not knowing how it will happen and the worry that there may be a tremendous amount of suffering in the process. The information and reassurance the hospice personnel are able to provide to patients and family members help them to understand the dying process and what can be expected and how their symptoms can be alleviated. This frequently will help decrease a great deal of the fear and anxiety of the unknown.
Social support can also be provided in finding community resources that may be helpful to the patient and/or family. Support groups with other family members of patients who have died with similar illnesses can often provide needed information and emotional support. The many details involved in arranging funeral services and burial or cremation plans can be facilitated by hospice workers, taking the majority of this burden off family members.
Hospice workers are often volunteers who have been trained in delivering this type of care. Many are trained employees of home health agencies. They often serve as liaisons linking patients and families with other health care professionals like physicians, pharmacies, oxygen companies, etc. The most important link should be to the primary care physician who should be available to provide medical support and initiate whatever palliative orders that may be required to control suffering. Nothing provides greater comfort to a patient and family than to have their primary care physician be involved in this process. A house call to a dying patient will never be forgotten.
Most hospice care programs require the patient to have an identified primary caretaker who assists the patient with meals, delivers medications and provides one-on-one care. This primary caretaker can be a family member, a friend or even a nursing facility who agrees to provide this care. The hospice personnel then provide support and guidance to the patient and caretaker throughout the dying process as mentioned above.
The increased utilization of hospice programs have been extremely helpful in managing end-of-life situations. They have provided great comfort for patients and families alike. Initiation of hospice care at the appropriate time should be remembered by primary care physicians as a wonderful resource for the proper comfort and care of dying patients. We would surely want this for ourselves when the time comes.
This page was last updated on October 9, 2010.