What if you’re ready for hospice, but your doctor isn’t?

Posted by Hospice by the Bay on Fri April 25, 2014 in Talking About Hospice

path-with-tall-treesYour illness is terminal. You have just six months to live. Your doctor recommends curative treatment, such as chemotherapy, saying it might give you a bit more time. You just feel sicker. Severe symptoms send you to the emergency room or hospital too many times. You just want to be comfortable for whatever time is left.

You ask about choosing hospice’s pain and symptom management to increase your physical comfort and quality of life. Your doctor resists. He doesn’t want you to “give up,or says, “You’re not ready for that.”

You usually follow your doctor’s recommendations. You don’t want to hurt his feelings or compromise your care by asserting your own wishes, but ….

Base your decision about hospice on your wishes for end-of-life care and whether you meet the medical eligibility requirements, and not your doctor’s feelings, says Dr. Molly Bourne, Hospice by the Bay Medical Director.

“Offering curative treatments, rather than suggesting hospice and comfort care, can be easier for doctors emotionally, especially with patients they know well,” she says. A survey of cancer physicians found that 65 percent said they’d tell a patient who was still feeling well that he or she had only four to six months to live, but only one in four would discuss the option of hospice care with that patient.

So what can you do?

“Call us, and we can have a conversation with your doctor,” Bourne suggests. “Ultimately, your physician wants you to have the end-of-life experience that you want, to die at home with hospice if that’s what you want. We can help ease resistance by describing all the ways that hospice comfort care helps patients live better and even longer than predicted.”

If you need to advocate for your wishes, here are Dr. Bourne’s tips for talking to your doctor about hospice:

  • Before your appointment, write down your questions and thoughts about hospice and bring them with you.
  • Rather than ask direct questions about hospice, ask about options. For example, “If I don’t do chemo, what are my options?”
  • You may feel emotional during the conversation. Bring a friend who can help you cover your list of questions and take notes.
  • Remember that your doctor will recommend what he or she thinks best, but you must be the final decision-maker regarding your own medical care.
  • At the end of the conversation, you can say, “I don’t want to decide now. I need to think about it.” That will give you time to think through your choices.
  • You can get a second opinion from another doctor who may refer you to hospice care.
  • Know that you have the legal right to refuse medical treatments, even if your doctor disagrees. It’s best if you affirm your end-of-life health care wishes by completing an advance directive or living will that documents your health care choices.

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