Adil Mohyuddin, M.D., a cancer specialist in Tullahoma, Tennessee, knew all the fine points about hospice care. His patients often trusted him to guide them through the flood of emotional decisions that come with a life-limiting illness. Even as a doctor with extensive hospice experience, he and his family struggled with the timing of hospice care during his own cancer diagnosis.
“Adil was trying to enroll in one last chemotherapy drug trial,” said his wife Sabina. “He was in pain and didn't think hospice was an option while waiting on the drug trial. When he finally chose hospice and got a pain pump, his mind and body had time to rest and he was more like himself. Although he passed away before getting in the drug trial, he didn’t have the stress that would often come with spikes in his pain.”
Even among the experts, making decisions in the face of a serious illness can be difficult and heart wrenching. Conversations near the end of life tend to focus medical matters and inadvertently push the goals and priorities of the patient down the road.
Patients often say quality of life is more important than how long they’ll live. Getting to the heart of what that really means for each person is the key to making the most of each moment.
Patients who talk with their clinicians about their values, goals and wishes are less likely to have non-beneficial medical treatment and report better quality of life. An ideal tool for sharing end-of-life goals is through advance directive documents.
If someone is having increasing difficulty with basic tasks such as walking, getting up from a chair, bathing, dressing or using the toilet, you may want to consider hospice. Hospice-appropriate individuals may exhibit some or all of the following:
- Repeat trips to the emergency department
- Progressive weight loss
- Unrelieved pain
- Frequent infections
- Sudden or progressive decline in physical functioning and eating
- Weight loss/difficulty swallowing
- Shortness of breath/oxygen dependence
- Individuals with an illness causing a limited life expectancy of six months or less, if the disease runs its normal course.
- Those who choose palliative care focusing on symptom management rather than curative treatment.
- Individuals who choose no extreme measures to sustain life.
Hospice is a fully covered Medicare benefit.
Coverage includes nurses, other caregivers, medicines, supplies and equipment, with no out-of-pocket expenses for the hospice diagnosis.