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Enjoy this post, written by Rhonda Sharp, MD, Associate Chief Medical Officer, Parkview Health.
Here in the United States we don’t do a very good job discussing or planning for dying and death. The topic carries a stigma similar to that of mental health, even though death is a fact of life for all of us from the moment we are born. For a patient with a terminal illness and their loved ones, hospice can be very scary. When you hear the word hospice, most assume it means their loved one only has a few days of life remaining. We need to begin talking about end-of-life issues – including hospice – when we are still healthy. It’s never too early to talk with your physician about living wills and how you would like to live your final days. And we need to be revisiting these decisions regularly as our views and even priorities may change as we marry, have children, retire, etc.
We, as physicians, could and should do better at initiating these frank conversations with our patients much sooner. If we have a long-standing relationship with the patient and the patient’s family, discussions about a living will should be part of their annual wellness visit. These discussions should also include hospice and other services available as we age. If we have these conversations routinely, then maybe the fear and discomfort will begin to decline (on both sides). We also need to ensure our patients are utilizing the services they need as most health plans will authorize hospice services if the patient’s condition makes it unlikely that they will live beyond six months. For a patient with a terminal illness and the families and friends who love them, hospice can help assure those six months are filled with events, conversations, celebrations, and memories that might never have occurred otherwise.
I’ve seen cases where hospice was utilized early, while the patient was still able to do things with friends and family. The hospice nurses, social workers and others on the team have helped families, caregivers and the patients do such a great job of managing the illness and symptoms, the patient truly lived their remaining days and sometimes even longer than six months. Although the patient was still suffering from a terminal condition, the exceptional care delivered by hospice and the family in coordination with each other made the added time possible. Weddings, graduations, one last visit to the lake cabin, reminiscing about shared memories … these priceless moments are what patients and families want most.
Hospice not only maintains the patient’s dignity. It also helps provide the means to live those final months to the fullest, right through the final day. It provides the patients and families guidance, relief and support, so when that difficult time comes, everyone knows what to do to honor the life of the patient.
