Quote from Susie2310
While I respect tewdles right to her opinion in her post above, I do not believe the patient or their family should be pushed into hospice discussions in primary care or acute care settings unless they initiate the discussion or express clear interest in the subject. As nurses and doctors, it is not for us to generalize about the value of our patients lives or what constitutes meaningful survival to them, and we (doctors and nurses) cannot accurately predict patient outcomes. Why remove the option of curative treatment? I did not read the article in JAMA as it required subscription, but the second article in HealthLeadersMedia heightened my intention to be very alert as to the care my older family members are receiving in all settings, from primary care through hospitalization. I do not doubt there are financial incentives on the part of the health care industry to try to move patients in to hospice as early as possible.
When my 90 year old aunt was diagnosed with pancreatic cancer and had to be told her odds of surviving the office nurse, an LPN asked her if she knew about hospice. She said she only knew a little but would like to know more.
She signed up for home hospice care a few days later.
Her six kids and as many nieces and nephews made a schedule so someone would always be with her. I took my vacation to spend a week with her.
We talked and looked at scrap books. I learned so much about her young life. From the time I was little she was a Mom. I remember cherishing one on one time with her as I handed her clothespins while she hung the wash on the line.
The good thing was that at first she was walking around the house, going to church, and such. She could hardly believe she was able to stay in her own house. She takled with my daughter just hours before she died. She laughed ans said, "I'm just in bed all the time now." then told her of all the family that was with her.
I was so impressed by the hospice nurse and the coung CNA who came to bathe her.
It is a wonderful program for people who choose it.
If I'm ever terminal I will choose hospice. If my family can't care for me I'll choose in-patient hospice.
(But may just have a CVA or get hit by a truck)
I do NOT think the topic should be brought up during a crisis. It takes time for patients and their loved ones to make decisions.