Talking with Patients About Hospice

Any conversation about transitioning to hospice should keenly focus on the needs and goals of the patient and family. The process of listening and clarifying patients’ wishes frames the rest of the discussion.

This resource lists step-wise tips to foster comfortable, productive dialogue for ‘the hospice conversation’.

• Ensure your understanding of the Medicare Hospice Benefit before discussing hospice with patients.
• For any patients with a diagnosis of a serious illness, use every visit to:
  • Build trust by listening to the patient’s story
  • Ask questions to understand the patient’s values and care preferences
  • Match values and preferences to the appropriate therapy or services. This process lays the foundation for conversations about hospice if and when they become appropriate.
• When a patient becomes eligible for hospice services, suggest holding a family meeting to discuss the Medicare hospice benefit and the value of hospice care (ideally in-person, but use video or phone call if needed)
  • Use the patient’s advance directive to help the conversation focus on goals and plan
  • Use communication techniques that help ease the distress felt by patients and health care professionals during difficult conversations. See CAPC’s communication curriculum for practical tips on discussion prognosis, advance care planning, and goals of care.
  • Avoid medical terminology; opt for language one uses when talking to a friend or relative. Allow for silence and reflection
• Let the patient’s needs be the focus of the conversation:
  • Start by asking the patient and family about their understanding of the patient’s medical condition. If they understand the condition is not curable, move the conversation forward with phrases such as, “We are in a different place now. Tell me about your hopes, fears, and wishes – what is important to you, now?”
  • Once wishes are clarified, describe the types of support that would address current needs, such as frequent visits from a nurse or additional help at home.
  • Explore the patient/family’s familiarity with and perceptions of hospice. Be prepared to clarify misunderstandings about how the service works.
  • Recognize that race and culture can impact patient and family attitudes about hospice. For example, our history of systemic racism and medical mistreatment in US health care has led many Black patients to distrust hospice care. Skilled communication, framing the hospice conversation around the patients’ needs and values, and respecting decision-making preferences with families can help to facilitate trust [1].
  • Assessing what reality is present to a patient or family who believes in miracles will allows us to then address what the underlining concern is. Getting to the root of the distress allows us to respond more effectively to families’ needs and can help build trust.
  • If hospice care is aligned with the patient’s needs and values, recommend hospice using language that connects back to what is important to the patient – “I hear that staying in your house and having the best quality of life possible is most important to you know. I would recommend hospice because that team can provide you with the maximum support at home.”
  • Describe the hospice benefit package, including:
    • No cost-sharing for patient
    • Full team including volunteer services
    • 24/7 on-call support and regular nurse visits
    • Home-delivered supplies, medications, and equipment
  • Remind patients that they are entitled to – and have paid for – the hospice benefit as Medicare beneficiaries
  • Remind patients and families that hospice care is not a one-way street – patients can change their minds and dis-enroll if their goals change or hospice is not meeting their needs
• Having the hospice conversation is not a one-time event. Should a patient decide not to enroll after an initial conversation, reintroduce the discussion at subsequent visits, focusing on the patient’s evolving needs and goals.