Why Palliative Care or Hospice?

Hospice is rarely used to its fullest.   A recent Dartmouth University study of Medicare patients found that most patients did not receive hospice care until the final three days of life.  Palliative is a fancy way of saying comfort care, which is what hospice is supposed to be.

A patient may begin hospice care if the treating physician and a hospice physician both find that the patient is likely to die within six months no matter how aggressively the patient’s disease or injury is treated. The finding is to be based on current medical science, the patient’s diagnosis and medical statistics regarding patients with a similar diagnosis.

Unlike most treatments under Medicare, all of the hospice treatment costs are paid by Medicare instead of only 80%. Even so, the cost of hospice care is usually much lower for the Government than if curative care had been attempted. Hospice payments do not pay for the cost or being in a facility. The cost of the facility may or may not be covered under Medicare or Medicaid depending on the underlying medical issues.

There are many reasons that doctors do not like to talk about palliative or hospice care. Doctors are not paid under Medicare or Medicaid to discuss with a patient or her advocate the various types of treatment available during the final stages of life. Death is obviously something most people do not like to discuss, and some doctors worry that the discussion of the diagnosis of terminal illness is likely to cause some patients to give up hope of recovery and/or enter depression. In an article published in the New England Journal of Medicine in 2012 research found that 70% of the persons in a sample of terminally ill cancer patients receiving chemotherapy did not realize that the treatment was not going to cure them. Boston Globe, Sept 5, 2013. Study Says Many Patients Enter Hospice Care Too Late. This result is amazing for two reasons: one is that 70% of the patients did not know they were receiving an expensive, painful and debilitating treatment that could not cure them of their cancer, Second, 30% knew the treatment could not cure their cancer and went through the treatment anyway.

Patients are more fully treated for pain and made comfortable in hospice than in curative care. There are many benefits to hospice among which are relief from pain and the ability to receive hospice care where a patient wants treatment, including: at home, a nursing home, hospital or specialized hospice facility. It is not unusual for a patient who enters hospice earlier in the terminal illness stage to live longer than six months. Upon request, hospice treatment can be extended beyond six months. If hospice is entered when a disease is first diagnosed as terminal it gives the patient time to come to terms with death, resolve emotional issues in broken relationships and also provides counseling for the patient, and for family members before and after the patient’s death.  Hospice may also provide more days of enjoyable life than if the patient went through curative care.

Further by choosing hospice instead of curative care the patient avoids the harmful side effects of the curative treatment the patient would otherwise have received. Even better some patients are found to live longer with the use of palliative care than with curative care. Hospice care is a treatment choice that should be considered and discussed by every patient facing medical treatment for an injury or disease that their physician expects will be fatal.

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