Hospice Care & Palliative Care: Choosing the Right Level of Care

In previous articles, I have discussed the benefits of hospice care for people with dementia or terminal illnesses. Now I will address the considerations that physicians and patients face when navigating the various options for hospice and palliative care. Choices for end-of-life care, when cure is no longer possible, have improved greatly in recent years. For instance, many hospitals now have palliative care teams to assist physicians in accessing the next level of care, allowing a peaceful life closure for both patients and family members. Sometimes patients can access both hospice care and palliative care programs simultaneously. Other times, hospice care can follow a palliative course in the hospital setting. In this article, I will explain the differences between receiving services from the hospital-based palliative care team and services received from a hospice agency.

Hospice Care Vs Palliative Care

The concepts of hospice care and palliative care are parallel, but generally do not intersect one another. Both philosophies provide quality of life when quantity of life is no longer possible. However, palliative care follows the curative course that the patient has been on, frequently in the hospital setting. On the other hand, hospice care follows the palliative course, is typically provided in the home rather than a hospital setting, and is appropriate when all curative measures, as well as therapies, have been exhausted.

Making the Choice Between Palliative Care & Hospice Care

When choosing between hospital-based palliative care or hospice care program, how can a physician know which one will provide the most benefit to the patient? And further, what constitutes a quality palliative care team? And: how does one choose an outstanding hospice?

A recent article in the Journal of the American Medical Association attempts to clarify the choices.¹ Today, physicians and patients can access over 1,400 hospital-based palliative care programs and there are now well over 4,700 hospice care programs in the United States. The reason for this expansion is to accommodate an aging population living with chronic illnesses; and, simply, a cure is not always possible. The good news is that these programs provide options to patients, and understanding the options allows families to make informed decisions about hospice and palliative care. This will be especially important to the 76 million baby boomers as they confront end-of-life issues for their parents as well as for themselves.

Physicians have been trained to make objective, well-thought-out decisions regarding end-of-life care for their patients. Choosing between a hospital-based palliative care team and a traditional hospice care approach will depend on the needs and desires of the patient as well as the disease trajectory. A good place for physicians to start is by learning what each option can offer, what to expect from each, and what guidelines should be used in choosing a program. But first, the physician should determine the patient's preferences regarding quality of life to help clarify mutual end-of-life goals. (Read more about why it's important to work with the patient's doctor regarding hospice and palliative care at the end of life.)

In my next article, I will continue an exploration of this topic, including how physicians can help determine the quality of a hospice agency before making a referral to a patient, and a basic look at the similarities and differences between hospice care and palliative care in the hospital and home environments.

Celebrating Life!

Audrey Wuerl

¹Teno, JM, Connor, SF, Referring a patient and family to high-quality palliative care at the close of life. Journal of the American Medical Association, 2009, (301), No 6; 651–658.

Posted in Hospice & Dementia Care