Recently I wrote an article for family members of patients who could benefit from hospice care and/or palliative care, in which I discussed the factors that physicians must consider in referring hospice or palliative care options hospice care provider to their patients. In this article, I will explore the topic in greater depth, discussing the similarities as well as the differences between the two primary options: hospital-based palliative care and traditional hospice-based palliative care.
Hospital-Based Palliative Care Hospital-based palliative care comes into play following a patient’s hospital admission, and prior to discharge. For example, if the physician orders chemotherapy, it could be administered in the hospital-but not by the hospice-as chemotherapy is considered a therapy (and precludes hospice admission). It is important to remember that hospitals are acute facilities that strive to restore patients to optimum function. Very simply, this means that they focus on therapeutic, rehabilitative measures.
When that is not a viable option due to a patient’s terminal or life-limiting disease, the hospital-based palliative care team can assist the physician in structuring a plan of care that strives to maximize quality of life while managing pain and symptoms. In this situation, the palliative care team might suggest an early hospice referral, as the patient would be leaving the hospital setting. Generally, while the patient’s doctor and the hospital-based palliative care team make the referral, the patient and family also participate in the decision, so that the outcome best benefits and supports the patient’s desires.
The physician must be confident the hospital-based palliative care team incorporates holistic care at its very base, including ensuring the patient’s physical comfort, providing emotional and psychological support, and supporting shared decision-making. In addition, the patient’s physicians should also be confident that the hospital-based palliative care team coordinates the care across different care settings and involves the patient and family as appropriate. A candid prognostic dialogue is paramount, as communication bridges the gap between the patient’s needs and the physician’s expertise.