Explain when it is appropriate to involve hospice and how to approach patients and/or families who refuse hospice services

If a patient has life-limiting illness like HIV, Stage 4 cancer with metastasis to multiple sites, or CVA with persistent vegetative state should consider hospice as a care option. Hospice is also recommended to patient or family that chooses comfort care, if a patient has a loss of functional or physical decline, has multiple comorbidities, dependence in most activities of daily living, and increase in ER visits and hospitalizations. Hospice is the comprehensive care system for patients with limited remaining life expectancy and can be provided at home or in institutional settings (Flaherty & Resnick, 2014). As a nurse practitioner, we have to assess the knowledge of the patient or family about hospice care because some of them think that it is one way of giving up the patient’s life. It is our sole responsibility to explain well to patient and family about the purpose and benefits of hospice care. We have to acknowledge and address their stress, doubts, and concerns about hospice care. We should explain to them that we are not giving up the patient, instead, we are there to support him and make him feel comfortable until his last breath. They should realize that hospice is a specialized palliative care limited to patients who have poor prognosis with 6 months or less to live. We should discuss to them about the comfort measures, alleviation of pain and the utmost quality care that he will get from hospice care. Since some families think that patient will be neglected, they should realize that hospice patients are cared for by an interdisciplinary team like physicians, nurses, social workers, chaplains, aides, therapists, dietitian, and volunteers. We should tell them that hospices provides medications, supplies, equipments, and other services related to the terminal illness. They should realize that if the patient condition improves, he can be discharged from hospice and may return to aggressive treatments or routine daily life. We should tell them that hospice staff will visit them regularly and have an access to a hospice physician. By providing a detailed explanation of the significance of hospice care, patients and family will not only be relieved from pain and stress but will also have the utmost quality care and quality of life that patient deserves (Flaherty & Resnick, 2014).

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