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Why Do People Unnecessarily Delay Entering Hospice?


Following are some of the reasons that prevent or delay patients from receiving hospice care:

  • A doctor's lack of knowledge about hospice care
    • Your doctor may not be knowledgeable about hospice care. A report in the New York Times indicated that a surprising number of doctors and hospital nurses, did not fully understand the potential benefits of hospice care or the requirements for hospice care. As a result, many of these doctors did not mention hospice care as an option to their patients.
  • Reluctance to Talk
    • Patients and / or their doctors may be reluctant to talk about death and end-of-life issues. Doctors in particular are trained to do whatever is necessary to keep people alive. They may see hospice as failure.
  • Misconceived Giving Up
    • Some people may view the decision to discontinue curative treatment as a sign of giving up. In reality, hospice care is designed to provide high quality end-of-life care.
  • Predicting Life Expectancy
    • A doctor may have difficulty in accurately predicting a life expectancy. An accurate prediction for people diagnosed with a chronic progressive illness such as emphysema, MS, ALS, and heart disease, can be especially difficult.
    • A doctor may be reluctant to provide an estimated life expectancy in writing as is required in the admission process for hospice care, even though doctors are not penalized if their prediction of life expectancy proves incorrect.
    • Doctors do not generally call upon the expertise of hospice agencies which may be able to assist with this evaluation.
  • Reluctance to disclose Life Expectancy
    • Many doctors are hesitant to provide patients with information about life expectancy.
    • In fact, doctors are sometimes overly optimistic in their predictions, resulting in the continuation of aggressive treatment long after it is effective. A study conducted by doctors at the University of Chicago Medical Center and reported in the Annals of Internal Medicine, involved interviews with 258 area doctors who referred cancer patients to hospice programs. The study revealed the following: in 23% of cases doctors would not give patients an estimate of life expectancy, even when asked; 40% said they would knowingly give an inaccurate estimate, usually providing a more positive estimate; and only 37% said they would provide their best estimate for those patients who asked.
  • A Supposed Burden
    • Some people may feel that home care would prove too great a burden on their family and loved ones. Patients seldom see the full impact their hospitalization has on the lives of their loved ones. At least if a patient is at home, the people around you can work in or around the house while helping.
  • Comfort
    • Many people feel greater comfort in the more structured setting of a hospital where health professionals continually monitor their symptoms around the clock.
  • Geographical boundaries
    • Distance can be a problem for people residing in rural areas. Home hospice agencies generally have travel limits, and are unable to provide care for people living outside of those boundaries. Alternatives might include staying with friends or relatives who live within a treatment area, or obtaining care at the nearest in-patient hospice facility.

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