A 28-year-old woman with a diagnosis of glioblastoma multiforme has recently decided to transition to hospice care following intracranial surgery and a course of chemotherapy. She has been informed by her oncologist that her prognosis is poor and that she will likely not live more than 6 months. The physician overseeing the hospice team visits the patient's home for a follow-up. During this visit, the patient mentions that she has been having second thoughts about choosing hospice care and, after speaking with family members and friends, feels that this would be "giving up." Her twin brother will be getting married in 8 months and she wants to attend his wedding. She has consulted 2 other oncologists who are experts in the field of glioblastoma for second opinions; they recommend an experimental life-prolonging chemotherapy regimen. She says, "I feel like I have to give this a try."
Which of the following responses by the hospice physician would be most appropriate?

Question

A 28-year-old woman with a diagnosis of glioblastoma multiforme has recently decided to transition to hospice care following intracranial surgery and a course of chemotherapy.  She has been informed by her oncologist that her prognosis is poor and that she will likely not live more than 6 months.  The physician overseeing the hospice team visits the patient's home for a follow-up.  During this visit, the patient mentions that she has been having second thoughts about choosing hospice care and, after speaking with family members and friends, feels that this would be "giving up."  Her twin brother will be getting married in 8 months and she wants to attend his wedding.  She has consulted 2 other oncologists who are experts in the field of glioblastoma for second opinions; they recommend an experimental life-prolonging chemotherapy regimen.  She says, "I feel like I have to give this a try." 
Which of the following responses by the hospice physician would be most appropriate?

Quizplus · Accepted Answer

Explanation: Hospice is a form of palliative care that provides medical care and psychosocial support at the end of life to patients who have decided to forego further life-prolonging therapies in favor of higher quality of life. Hospice care consists of an interdisciplinary team of physicians, nurses, social workers, mental health providers, and spiritual care providers who are available to patients and family members 24 hours a day, 7 days a week. Services are most often provided in the home but may also occur at a free-standing facility or hospital. Criteria for hospice include a diagnosis of life-limiting illness with an estimated prognosis of <6 months. Patients are permitted to leave hospice to receive life-prolonging treatments and are free to return as long as they continue to meet these criteria. Patients on hospice can receive palliative medical therapies (eg, chemotherapy, radiation, tumor debulking) to improve comfort, but aggressive disease-modifying therapies with curative intent are not consistent with hospice care (Choice D). (Choices A and B) Choosing between hospice care and experimental therapies is a difficult, personal decision. The hospice physician must support this patient's decision and encourage her to discuss the risks and benefits of specific therapies with her oncologist. If the physician is concerned that the patient is ambivalent, an open-ended discussion should be held. Suggesting that her family members are pressuring her or that the decision is unwise is paternalistic and may be experienced as judgmental. (Choice E) It is the role of the oncologist who is familiar with the treatment, not the hospice physician, to discuss the risks and benefits of the new chemotherapy regimen the patient wishes to pursue. Educational objective: Hospice care is an interdisciplinary palliative care service for patients with life-limiting illnesses (prognosis of <6 months) who have chosen to cease disease-modifying, curative therapies. Patients are free to leave hospice at any time to pursue curative treatments and can return later. References: Understanding palliative care and hospice: a review for primary care providers. (http://www.ncbi.nlm.nih.gov/pubmed/28160875)

A 28-Year-Old Woman with a Diagnosis of Glioblastoma Multiforme Has