Hospice and end-of-life care
Care in the last months of life focused entirely on comfort, at home or in a hospice, when cancer treatment no longer helps. Enrolling earlier than the typical two to three weeks gives patients and families more benefit.
Modern hospice began with Cicely Saunders at St Christopher's (1967); the US Medicare hospice benefit (1982) requires a six-month prognosis and forgoing curative treatment, which creates late referral (median length of stay ~18 days). Elements: symptom control, home nursing, bereavement support, and avoidance of chemotherapy in the last 14 days and ICU death (ASCO/NQF quality measures). Evidence links hospice to better family-rated care, lower costs, and no shortening of life. Concurrent-care models (VA, Medicare Care Choices pilot) allow hospice alongside treatment. Medical assistance in dying is legal in a growing number of jurisdictions and interacts with palliative care policy.
How it works
Prognosis-triggered transition to comfort-focused interdisciplinary care with 24/7 access, delivered predominantly at home; quality is measured by late-enrolment, aggressive end-of-life care and family-reported outcomes.
- Better family-reported quality of dying
- Lower end-of-life costs and hospital use
- Bereavement support for caregivers
- Late enrolment; 'terrible choice' between treatment and hospice in the US
- Underuse by Black and Hispanic patients and in rural areas
- Non-existent in many countries
Latest papers
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