Start the Conversation
Why Talk About Hospice?
There’s a common misconception that hospice care means the patient and their family are giving up.
This is not true. Hospice care allows patients to have a higher quality of life by managing their pain and symptoms related to a terminal diagnosis.
Many physicians wonder when it’s appropriate to bring up the critical conversation of hospice care. It it in the patient’s best interest to have the conversation as soon as you suspect the illness is terminal.
"A large, diverse, and consistent body of evidence demonstrates that early discussions of serious illness care goals are associated with beneficial outcomes for patients, without harmful adverse effects."
"Communication about Serious Illness Care Goals," JAMA Internal Medicine
Discussing End-Of-Life Care
- Initiate the conversation: Choose your words carefully to set the tone for the meeting.
- Example: “I’d like to talk about where we are with your care and make plans for the future.”
- Include family/friends to provide emotional support to the patient.
- Allot adequate time: Rushing the conversation can leave patients feeling unsupported.
- Ask the patient questions: Find out what the patient understands about his/her health status.
- Example: “Tell me what you’ve been told about your illness.”
- Example: “How are you feeling about where you are with your illness?”
- Get permission to divulge information: Most patients will want to know everything about their illness, but some may not.
- Example: “How much information do you want me to give you about your illness? Do you want all the details?”
- Determine the patient’s care goals: What is most important to the patient? If the patient mentions being tired of treatment or wanting comfort care, it may be a good time to introduce hospice.
- Example: “What do you hope to achieve with the current treatment and what do you see for yourself in the future?”
- Be prepared for opposition: The patient may come to a different conclusion about hospice care.
- How to address: “That’s fine if you don’t want to talk about this right now. Maybe we can discuss it later if your situation changes.”
- Lead with a “warning statement”: Give the patient a few moments to prepare for the news you are about to share.
- Example: “I’m so sorry to tell you…”
- Example: “I wish I had better news for you, but unfortunately…”
- Always be honest about prognosis: Resist softening the blow by encouraging false hope in a care if there is little chance of recovery. Talk openly to the patient about what will happen and provide straightforward information.
- Speak slowly, clearly, and with expression: Avoid doing all the talking. Pause often to allow the patient to ask questions.
- How to address: “What questions do you have?”
- How to address: “What can I further explain to you?”
- Give information in small pieces using simple language: Be sure the patient fully understands what you are saying. Mirror the patient’s language and avoid medical jargon. Ask the patient to explain the information in their own words before changing topics.
- Allow the patient to think, speak and display emotion: The patient needs time to process thoughts and feelings. It’s OK to have moments of silence during the discussion.
- Identify the patient’s emotions and their causes: If you’re unsure of what the patient is feeling or why, ask open-ended questions.”
- Asking “How do you feel about the test results?” is better than “Are you disappointed with the test results?”
- Be supportive and empathetic to the patient’s feelings or emotional outbursts.
- Example: “The results of the tests are very worrisome.”
- Example: “I can see why you would be so upset.”
- Help the patient and family redirect their goals from recovery into planning for a peaceful and comfortable end-of-life journey.
- Example: “We can plan for better pain control and maximize your quality of life from day to day.”
- Establish a care plan together: Discuss the steps involved in hospice care, how it can help, and how services can be integrated.
- Review what was discussed at the end of the conversation. Ask the patient what additional questions they may have.
When to Refer to Hospice Care
There are multiple benefits of referring patients to Cedar Valley Hospice earlier. Our services include 24/7/365 nursing availability, personal care, family support, caregiver education, medication management, durable medical equipment, emotional and spiritual support, therapies and grief counseling. Generally, patients who enroll in hospice care report a higher quality of life and a reduction in unnecessary ER visits. We often hear from patients and families, “We wish we would have called Cedar Valley Hospice sooner!”
How to Make a Referral
Some or all criteria listed may be present to qualify for hospice admission. The presence of multiple diagnoses may support admission to hospice. For more information, or and admission evaluation, call Cedar Valley Hospice
When to Refer
Hospice Meds
Karnofsky Scale
PPS (Palliative Performance Scale)
FAST (Functional Assessment Stage) Scale
Common GIP Symptoms
Physician Newsletters
Service Area Map
General Information Brochure
LINK Palliative Care Brochure
Hospice Home Brochure
Grief Brochure
CASS – HIV Case Management Brochure
S.O.S (Speakers on Site) Brochure
Have a Referral?
Anyone can refer a friend or family member to Cedar Valley Hospice. Simply complete and submit the form below to get started. If you have any questions, please give us a call at 800.626.2360.
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Enriching lives in the Cedar Valley is at the forefront of our mission. We are experts in providing hospice and palliative care, grief support and providing additional services for those with life changing diagnoses. As a not-for-profit organization, your gifts make our mission possible!
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