Hospice Care Health Article

Definition

Hospice care is palliative care given to individuals who are terminally ill, with an expected survival of six months or less. The focus of hospice care is on meeting the physical, emotional, and spiritual needs of the dying individual, while fostering the highest quality of life possible.

Description

Hospice services provide palliative care to individuals with a life expectancy of six months or less. Most hospice care is provided in the home, but may take place in a hospice home or a hospice/palliative care area within a medical facility. Requesting hospice care may be the first time that individuals, or their families, acknowledge that their condition is not treatable. It may be the first time that they have to deal with their death as a reality taking place within a few months. The emotional journey to be able to deal with these issues may take a while, and therefore may delay the time when the person begins to receive hospice care.

The focus of hospice is not on treatment, but on pain and symptom management, comfort measures, acknowledging that the individual will die, supporting the family, and trying to provide the best quality of life for the time remaining. Hospice functions under the philosophy that although some terminally ill patients may no longer receive treatment, they still require and deserve care.

Hospice care is interdisciplinary in nature, providing the services of physicians, nurses, social workers, physical, speech, or occupational therapists, clergy or other spiritual guides, health care aides, and volunteers. Home hospice care relies on the family and friends of the patient to provide most of the daily care. Nursing and other services are provided daily or weekly, but with 24 hours, 7 days a week on-call access. Addressing the spiritual needs of the hospice client is a fundamental aspect of hospice care.

Some studies about hospice care have gleaned the following:

• When asked their preference, about two-thirds of cancer patients said they preferred to die in their own home.
• The majority of patients still die in the hospital.
• When surveyed, about 95% of families who received hospice care said that it had been helpful.
• Although satisfied with hospice care, caregivers report the job of caregiving as having a negative impact on their own quality of life, and felt the job was burdensome.
• When compared to a control group of noncaregivers, caregivers had higher levels of depression, anxiety, anger, and health problems. Caregivers had a higher rate of deteriorating health, social, and occupational functioning.
• Quality of life was influenced by the individual's spiritual well-being.
• Hospice patients expressed feelings of conflict between a hope for living, and "living in hope, " being able to reconcile with others and coming to terms with death.
• Although hospice is focused on helping people in the last six months of their life, most hospice patients only receive about one month of hospice care prior to their death.
• Only 20% of physicians' prognoses about a patient's survival was accurate. Sixty-three percent were overly optimistic, and 17% were overly pessimistic. The more experience the physicians had, the better their accuracy of prognosis.

Causes

Hospice care was first established in the United States in 1974 in Connecticut. In 1969, the book "On Death and Dying", by Dr. Elizabeth Kugler-Ross identified five stages that a terminally ill person goes through. In the book, Dr. Kubler-Ross addressed the importance of patients having a role in the decisions affecting the quality of their life and death. In 1972 she testified at the first U.S. Senate national hearing on dying with dignity.

Deciding on hospice care is a choice made by the terminally ill individual. To be eligible, one's physician needs to document that the individual's survival is expected to be six months or less. Should the patient recover, and the prognosis change, the relationship with hospice is terminated, but can be reestablished when needed at a later date. Not all patients will choose hospice. If only home hospice care is available, individuals who would be eligible may decide that hospice is not a good choice for them. Reasons for not choosing home hospice include:

• The patient lives alone, with little or no family support available.
• The patient has a need for 24-hour nursing care.
• The patient has family, but they are unable to provide the supportive care required.
• The patient is concerned about being a burden to the caregiver.
• The patient feels more secure in a hospital environment.