How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?

Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...

So when I see this question in the “hospital medicine” section, and the question has a “but” in it, I focus on the statement after the “but”. (If interested, see this link on Meaningful Conversations for medical students.)

“....but who are hesitant to formally enroll in hospice?”

So the first questi...

First, I recap their health situation in realistic terms, but I ask how much the patient wants to know about the prognosis (especially if the person asking is a family member). I ask if patients have a living will and what it says. I ask them (if they have one) to have it entered in their chart. I d...

It is already a strength that patients/families express their goals, already aligning with a comfort-focused, end-of-life care approach. Oftentimes, the barriers in emotion and system resource practical considerations make people hesitant to opt for hospice care. The concept of hospice care can be d...