Palliative Care, Hospice and End of Life Myths Unveiled

By Dr. Movaghar


In this post we will discuss common palliative care, hospice and end of life myths. You can also read the GeriAcademy related blog post on common geriatric myths.


1. Hospice is giving up!


Far from it! Hospice care is medical care – but specialized – for those with a terminal illness. The focus is more holistic and all-encompassing … more so than most other medical specialties. It is directed at comfort and quality of life for however long you may have left in your terminal illness's natural progression. And it literally takes a village of different specialty providers to determine and design what your hospice care will entail – including multiple physicians, nurses, therapists, social workers, spiritual counselors, to name a few.


2. Only patients with cancer can have hospice.


Not true. Unfortunately, there is a myriad of terminal illnesses, including but not limited to: end-stage COPD, end-stage heart failure, end-stage kidney failure, stroke, dementia, some neurological conditions, and AIDS. The two biggest components to qualify for hospice care are 1) that you have a terminal illness and 2) that your doctor estimates you have a short time to live (typically 6 months or less).


3. Palliative Care means I cannot have lifesaving treatment.


Also, not true. To demythify this myth, let me briefly explain the difference between hospice and palliative care. They are equal in that both focus on comfort and quality of life once you have been diagnosed with a terminal condition; however, you are still pursuing treatments intended to cure the illness under palliative care. Whereas with hospice, you have elected to let the disease take its natural course but still treat the disease's symptom burden.


4. DNR means do not treat.


Absolutely FALSE! DNR stands for DO NOT RESUSCITATE. A medical order is written by a doctor who instructs medical providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. Simply put, if you were to be found already dead, then no one would intervene – they would honor that natural death. That is completely different from being found still alive!


5. All patients in hospice go to the "hospice house."


Hospice care can be provided in many locations – in your own home, in a nursing facility, in a hospital, and yes - in a hospice house. It really comes down to your wishes and current living situation. Hospice is not a place where you go, it is a philosophy!


6. A feeding tube will keep my family member with dementia alive longer.


Not necessarily. What it can prolong is their suffering. Loss of appetite is part of the normal progression of dementia. It is a sign of advanced disease. It can be a major marker for when death is near. Artificially feeding someone whose body is getting ready for death is unnatural, painful, and uncomfortable. And studies have not shown that it extends life. Additionally, patients with dementia may need to be restrained due to attempting to pull on feeding tubes.


7. You can only be on hospice right before death.


The decision to enroll in hospice is a personal and individualized one. However, studies have shown that patients who enroll sooner rather than later have been found to live longer and more comfortably, and with dignity.


8. I don't need a health care power of attorney; I can make my own decisions.


It couldn't be truer – for as long as you are fully conscious and oriented. Now let's say you are in a coma, or confused, or heavily sedated… then it's a different story. A healthcare power of attorney (HC-POA) only kicks in when you are not conscious AND fully oriented. And even then, your designated HC-POA is legally bound to act and make decisions as you would if you were able to.


9. I just got admitted to the hospital, and they asked me what I would want if my heart was to stop. They probably expect that I may die soon.


This is standard procedure for ANY patient being admitted to a hospital, regardless of age, race, religion, socioeconomic background, insurance status, etc. You should be more concerned when you're not asked this! It's as important as asking what your drug allergies are.


10. Doctors can predict when someone is going to die.


No – nor should we have the audacity to do so. Based on statistical evidence from people in similar medical situations, we can tell you what a timeline might look like. We might give a range, but even then, it's not guaranteed.


Summary


I hope you enjoyed reading this blog post. Check out 10 Myths about Geriatrics on GeriAcademy.


This Post was written by Dr. Sara Movaghar DO, she is board certified in Internal Medicine and Geriatric Medicine. She is currently employed at Carolinas Health Care System, Blue Ridge.

References:


"What Is Hospice?" Hospice Foundation of America, hospicefoundation.org/Hospice-Care/Hospice-Services.


"Hospice." National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/topics/hospice.


Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, Christakis N. A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ. 2003 Jul 26;327(7408):195-8. doi: 10.1136/bmj.327.7408.195. PMID: 12881260; PMCID: PMC166124.


Anantapong, Kanthee et al. "Mapping and understanding the decision-making process for providing nutrition and hydration to people living with dementia: a systematic review." BMC geriatrics vol. 20,1 520. 2 Dec. 2020, doi:10.1186/s12877-020-01931-y