Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor i...

My two cents, with experience taken from my prior life as a hospice physician: Ask yourself "would I be surprised if this patient were to die within 6 months? Within 1 year?" If you would not, hospice should be on your mental radar. Hospice enrollment requires certification of terminal illness wit...

I agree with the statement that the most important factor is patient and caregiver preference. For this to work optimally, they need to know that it is an option.  Expanded hospice allows earlier enrollment of patients while receiving concurrent disease modifying therapies. We have access to e...

While patient and caregiver preferences are paramount, it is an intensely emotional time for them, and we owe it to them to provide some guidance. I think it helps to start the discussion early, perhaps at a first recurrence (or some significant medical setback), just so the mention of hospice is le...