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Last Updated on November 12, 2021 by Frank Davis
The decision to refer your patient to hospice is one of the most difficult decisions for a doctor. It’s not easy to see that your patient’s condition has declined and that they are no longer able to adequately care for themselves. It can be mentally taxing, physically exhausting, and emotionally agonizing. One way to get through this difficult process is by understanding when it is appropriate for you refer your patient to hospice care.
This article has been written to help you decide how to proceed, as there is no one thing that will indicate whether your patient should be referred to hospice. There are a number of different factors that may indicate it is time to refer your patient to hospice.
When should I refer my patient to hospice
Many doctors believe that hospice is for patients that are near death, but this is not true. It is not necessary to wait until your patient’s condition declines before referring them to hospice; in fact, waiting too long may lead to more aggressive measures that could compromise the quality of their life while simultaneously extending the period of time it takes for them to pass away naturally.
It is important to understand that your patient can still live a full and meaningful life despite their health issues. They should be able to maintain as much independence as possible and feel as comfortable as they can on a day-to-day basis. If you notice that they’re no longer able to do things they once were able to do, are experiencing pain that is not being adequately treated, are acting differently than normal, or are having difficulty maintaining their quality of daily life then it is time for you to consider referring them to hospice care.
There are many factors that will determine whether it is time to refer your patient to hospice. Some of it will depend on their age, others on their stage of cancer, and others on their general health. There are some general guidelines that can help you decide when it is time for you to refer your patient to hospice care.
Of course, you’ll know your patient is nearing the end of their life when they are older. But some patients are on the downward slide due to their advanced age before they even present for care at your office. If an older patient is having problems with talking, walking, bathing, eating or dressing on their own then it may be time to consider hospice care for them.
Patient stage of cancer
There are patients that are diagnosed with cancer, but continue to live for many years. Typically, these people will receive chemotherapy and/or radiation treatment to help them better manage their cancer. If chemotherapy or radiation treatments no longer seem to be working it may be time for you to consider hospice care for them.
Patient general health
If your patient has significant problems with any number of diseases or conditions it may be time for you to consider hospice. This can mean they have heart disease, respiratory disease, kidney disease, liver disease, uncontrolled diabetes, and so on. It can also mean that they have problems with their vision or hearing that interfere with their daily life.
Complications at home and rapid decline
If your patient’s condition is complicated by infections and/or falls at home then it may be time for you to consider hospice care for them. If they are losing their ability to function as a result of their illness or if they are experiencing rapid deterioration in health it may be time for you to consider hospice care for them.
If your patient is unable to manage their symptoms (i.e., delusions, hallucinations, nausea, vomiting, constipation) with medications or alternative treatments then it may be time for you to consider hospice.
Desire for a dignified death
If your patient has clearly stated that they do not want to live their life in pain and/or discomfort then it may be time for you to consider hospice. This means that they’re concerned about what will happen if they end up in an intensive care unit, after the point where they’re no longer able to manage or adapt well to their treatment or care or if they become too sick and no longer be able to function as a result of their illness.
This are just some of the more common indicators of when it may be time for you to consider hospice for your patient. You’ll need to study the specifics of their illness and current treatment plan to determine if it’s time for you to refer them to hospice. A consultation with a palliative care specialist can help you understand what options are available and how they can help your patient.
If you’ve considered all of the factors above and are still unsure if it’s time for you to refer your patient, then there are a few more questions you can ask yourself. For example, what would the outcome be if you do not refer them to hospice? Would their quality of life be negatively impacted? Would they be miserable? Would they end up with medical complications that could have been avoided with better care? If you answered yes to any of these questions it may be time for you to consider referring them for hospice.
Furthermore, patients are not required to wait until they are near death before being referred to hospice. If your patient experiences an unexpected and rapid decline in health and is no longer able to maintain their quality of life then it may be time for you to consider hospice. You can send your patient to see their primary care physician, but if necessary you can also call the hospice team for help.
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