How to Communicate About Palliative and Hospice Care with Patients and their Families

Setting the stage for a meaningful conversation about a patient’s and their family’s wishes and/or treatment options is an important link in quality cancer care. At some point in the care of every patient, a crucial conversation must be held with the patient and their family regarding goals of care. Goals of care may simply be desired outcomes spoken in agreement but oftentimes are assumed or partially discussed and thereby misunderstood by those caring for a cancer patient.

Many times, this crucial conversation is had later in the patient’s disease process than optimal. While timing is important, the conversation can be shared at any point in a patient’s care. Ideally, introducing the palliative care team from the very start as experts in symptom management begins the conversation. As the patient’s journey continues, hospice can be introduced when treatment modalities and clinical trials no longer hold promise. Thankfully, many patients do not get to this point in the cancer journey, but it is always important to share the definition and conditions of hospice.

Palliative care and hospice care have similarities and differences that the patient and family will need to be made aware of to make the decisions that best fit their needs, values, and the timing of the disease progression.

For providers, it is vital to have a script for holding this particularly important conversation so that they can focus all their attention on patient/family questions and assist them to make the most meaningful decisions.

Palliative care as defined by the National Consensus Project for Quality Palliative Care is “expert assessment and management of pain and other symptoms, assessment and support of caregiver needs, and coordination of care. Palliative care attends to the physical, functional, psychological, practical, and spiritual consequences of a serious illness.”¹ Palliative care can be introduced at any time during a serious illness and intersects between the patient/family’s values and goals and current treatment plans.

Hospice is “a philosophy of care and a regulated insurance benefit.”² As a philosophy of care, it mirrors palliative care’s compassionate and high-quality end-of-life excellent care with the exception that care now will not focus on disease-directed treatment with cure as the intention. Hospice requires a prognosis of six months or less and may begin in the terminal phase of illness when cure is no longer possible, or the patient chooses not to undergo certain treatments focusing instead on comfort-oriented goals. As a regulated insurance benefit, patients qualify for hospice care by meeting certain eligibility requirements. “There are four levels of care per Centers for Medicare and Medicaid (CMS) regulations—routine, inpatient, continuous, and respite care.”³.

Starting hospice earlier than later can provide months of meaningful care and quality time with the patient’s loved ones. Hospice is usually provided at home but can be offered in a facility such as a nursing home, hospital, or short-term hospice unit near the patient’s home. A common misconception is that palliative care and hospice are synonymous. Although there are many similarities, such as symptom-focused whole person care and focus on the patient as well as their family provided by an interdisciplinary team, there are specific differences between these types of care.

Similarities and differences are key in understanding what each care delivery model offers the patient/family. Having a simple chart with similarities and differences is important to review and leave with the patient/family. One educational resource that anyone can access online is “Palliative Care or Hospice? The right service at the right time for seriously ill individuals,” provided by the National Hospice and Palliative Care Organization.⁴ This document compares the two services and helps to set the stage for further conversations.

Relationships are important throughout the continuum of care and taking the time to develop descriptions and focus ideas related to palliative and hospice care can assist a novice or a seasoned provider in a more meaningful conversation about their patient’s serious illness and what care delivery can be provided.