I’m not ready for hospice”: strategies for timely and effective hospice discussions. Ann Intern Med

Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hos-pice organization and financing. However, the challenges of dis-cussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article de-scribes a structured strategy for discussing hospice, based on tech-niques of effective communication that physicians use in other “bad news ” situations. This strategy can make hospice discussions both more compassionate and more effective. Ann Intern Med. 2007;146:443-449. www.annals.or