Difficult Conversation: Tips for Starting a Hospice Conversation

As seen in the Consultant Connection December 2014 Issue
Irene Sours, RN, WCC, ICP, Inc. Nurse Consultant
For many health care providers working in assisted living facilities or nursing homes, beginning a conversation about hospice care with a resident or family member can be extremely difficult.  However, as a trusted source of information, you can play an important role in ensuring residents are informed and receive the most appropriate care available to them.
Hospice care focuses on the chronically and terminally ill or seriously ill patient’s pain and symptoms, while attending to their emotional and spiritual needs. 
When should I talk about hospice care?  There are a number of circumstances that may lead you to consider talking about hospice care with the resident, family member and/or the resident primary physician:
  • Following diagnosis of terminal illness
  • After repeated hospitalizations or trips to the emergency room
  • When resident express interest or you see consistent decline
  • When resident and/or family is requesting no further treatment or doctor visits

It is important to educate STNA’s, housekeeping, volunteers who may have the most contact with residents
How do I start the conversation?
  • Choose a private, relaxed time when you can have a one-on-one discussion with the resident or their family member without distractions.  Be sure that the resident or family member is comfortable.
  • Looking for an opening in the conversation will make the discussion easier; such as when the resident refers to his or her condition, or perhaps talks about “giving up” on treatment. 
  • Most importantly, remember to ask and then listen.  Ask open ended questions (those without a “yes” or “no”) answers to get the conversation going.  Let the resident respond; your silence is OK.
  • Don’t wait to start talking about the disease process of the diagnoses such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotophic Lateral Sclerosis (ALS), etc.  Use terminology that is simple and easy to understand.  Education is so important for an informed medical decision.  Discuss the disease progression utilizing resident test results (x-rays, labs, etc.)
  • Discuss the benefits of the hospice team combined with your facility team and the resident’s doctors to provide an extra layer of support.  Focusing on providing the resident with relief from symptoms, pain, and stress of a serious illness-whatever the diagnosis.  The goal is to improve quality of life for both the resident and the family.
  • Educate the resident and family that choosing hospice care does not indicate that all treatment is withdrawn.  Chronic illnesses are treated, as well as acute issues, such as infections, fractures, etc.

Just remember talking about hospice care does not mean you can’t do anything else for the resident.  It doesn’t mean there is no hope.  It can actually be comforting to know there is another source to help and support.
Reference: National Hospice and Palliative Organization.   http://www.nhpo.org/ 

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