A 78-year-old man with end-stage esophageal cancer is admitted to the hospital with severe malnutrition and failure to thrive. The patient's caretaker says that he has not been able to eat or drink for the last 3 weeks. His weight dropped from 72.6 kg (160 lb) to 63.5 kg (140 lb) during that time. The cancer has spread to his lungs and liver. The patient does not wish to receive any further treatment for the cancer and specifies that he wants no heroic measures or interventions to keep him alive. His physician considers referral to hospice care. Which of the following is a requirement for referring a patient for hospice care?

Question

A 78-year-old man with end-stage esophageal cancer is admitted to the hospital with severe malnutrition and failure to thrive.  The patient's caretaker says that he has not been able to eat or drink for the last 3 weeks.  His weight dropped from 72.6 kg (160 lb) to 63.5 kg (140 lb) during that time.  The cancer has spread to his lungs and liver.  The patient does not wish to receive any further treatment for the cancer and specifies that he wants no heroic measures or interventions to keep him alive.  His physician considers referral to hospice care.  Which of the following is a requirement for referring a patient for hospice care?

Quizplus · Accepted Answer

11ec160b_365c_69a1_9249_9df97249a947_MD0001_00 Hospice care is usually provided to terminally ill patients with a prognosis of <6 months, when aggressive, curative treatments are no longer beneficial or desired. The largest population receiving hospice care consists of cancer patients, but also includes those with other terminal medical conditions (eg, end-stage cardiomyopathy, end-stage chronic obstructive pulmonary disease, pulmonary fibrosis). The physician must substantiate a prognosis of <6 months with documentation of irreversible decline in clinical and functional status. Hospice care is based on the principle of providing compassionate care that focuses on comfort and quality of life. It is provided by a multidisciplinary team that includes nurses, social workers, chaplains, and a hospice physician who closely coordinates with the patient's attending physician. It can be provided in the patient's own home (home hospice care), a nursing home, or dedicated hospice facility. Hospice services include comfort measures (eg, control of pain and dyspnea) and psychological, spiritual, and bereavement counseling for patients and families. (Choices A and E) Hospice care is appropriate for patients with any terminal illness provided they have a prognosis of <6 months. (Choice B) Although most patients in hospice care have directives to decline heroic life-sustaining measures, a do-not-resuscitate order is not a prerequisite for receiving hospice services. (Choice C) Patients who still possess decision-making capacity should participate in decisions regarding hospice care. However, advance directives or surrogate decision makers may handle issues related to hospice care for patients who lack capacity. Educational objective: Patients with advanced metastatic cancers or other terminal illnesses and a life expectancy of <6 months should be evaluated for hospice care. __________ References: Hospice care in the United States. (http://www.ncbi.nlm.nih.gov/pubmed/21628033)

A 78-Year-Old Man with End-Stage Esophageal Cancer Is Admitted to the Hospital