A 48-year-old woman is admitted to the oncology service for the 4th time in 2 months. She was diagnosed with breast cancer 2 years ago and has endured surgery, chemotherapy, and radiation. She also participated in multiple experimental trials. Unfortunately, her disease has progressed. Today, the patient is hospitalized for hemoptysis and shortness of breath. She complains of severe pain in her back and has lost another 5 pounds since she was discharged 2 weeks ago. Her body mass index is 17 kg/m². The patient has expressed a wish to stop all treatment, go home, and enjoy her remaining days. She is found to have the capacity to make this decision. The oncologist, patient, and patient's family decide that hospice care is the most appropriate plan. Which of the following is considered a requirement for referring a patient for hospice care?

Question

Quizplus · Accepted Answer

11ec25c8_d52f_81bf_bc81_29845acc7c30_MD0003_00 Hospice services provide interdisciplinary palliative care for patients with a prognosis of <6 months. Hospice care involves a patient-centered approach that emphasizes quality of life, comfort, and death with dignity. It is appropriate when aggressive curative treatments are no longer beneficial or desired. The physician must substantiate a prognosis of <6 months with documentation of irreversible decline in clinical and functional status. Hospice services include comfort measures (eg, control of pain and dyspnea), logistical support (eg, home health care, durable medical equipment), psychological and spiritual counseling, and bereavement support. Hospice services can be provided in a home, nursing home, assisted living facility, or dedicated facility. Common misunderstandings regarding hospice eligibility include beliefs that the patient must be actively dying and have a do not resuscitate order (Choices C and F). While most patients on hospice care have clear instructions to decline heroic life-sustaining measures, this is not a prerequisite to receive hospice services. (Choice A) Although functional decline is involved in assessing prognosis, it is not a required criterion for hospice eligibility. (Choice B) Lack of family and caregiver assistance is not a requirement. In fact, many hospice services are designed to provide support for families and caregivers. (Choice E) Patients should be included in all decisions as long as they have capacity. In those lacking capacity, decisions regarding hospice care can be made using advanced planning directives or surrogate decision makers. Educational objective: Hospice is a palliative, interdisciplinary model of care for patients with a prognosis of <6 months. The focus is on symptom control; quality of life; and psychosocial, spiritual, and bereavement care. References: Hospice care in the United States. (http://www.ncbi.nlm.nih.gov/pubmed/21628033)

A 48-Year-Old Woman Is Admitted to the Oncology Service for the 4th