Where Do We Go From Here?

Hospice Foundation of America's recent teleconference called Cancer and End of Life Care explored the many issues surrounding transitioning terminally ill patients from curative treatments to other care options such as hospice.

Dr. John Hausdorf, a Monterey, California, oncologist and panelist at our teleconference broadcast site said that new cancer therapies try two avenues: one to cure the cancer and another to prolong life by slowing down the progression of disease.

It's great that there are many more options today. But when the cancer is incurable, often the patient and family still want to try additional treatments. Sometimes these treatments can greatly impact the patient's quality of life because of debilitating side effects. So it leaves health care providers, patients and their families grappling with a timing question: when does hospice care become the better option? To go on hospice, the patient must forego any additional treatment.

This leaves one to ask, why can't patients have it both ways? Hope for a cure but also the ability to gain additional care and support if needed. Why can't compassionate, home-centered care that supports the dying patient become a natural part of the health care continuum...why must patients choose one course over another? Shouldn't it just be seamless?

Unfortunately, Medicare and private insurance companies haven't yet figured out a way to contain the costs of seamless transitions to end of life care. They require patients to exit and enter different modes of treatment which have different rates of reimbursements to providers. So while hospice is a wonderful choice, the fact that IT IS A CHOICE is in itself a barrier for people. They don't realize that hospice does allow patients to live to the fullest extent possible, under the circumstances, with care, comfort and dignity.

The system needs to change to recognize these needs.

Healthcare choices for people at the end of life should be seamless. Patients and families should not have to make such difficult choices--whether or not to stop treatment--be required to give up something to get something else. Hospice care should be available to all as a matter of course in our end of life health care delivery.