Name of the Procedure:

Hospice Care (G9690)

• Common names: Hospice care, End-of-life care
• Medical terms: Hospice services

Summary

Hospice care is a type of medical care specifically designed to provide comfort and support to patients who are in the terminal stages of a serious illness. It focuses on the quality of life rather than curative treatment and includes physical, emotional, social, and spiritual care.

Purpose

Hospice care is intended for patients who have a terminal illness with a life expectancy of six months or less if the disease follows its natural course. The primary goals are to manage pain and other distressing symptoms, provide psychological and spiritual support, and help patients and their families cope with end-of-life issues.

Indications

• Patients diagnosed with a terminal illness and a prognosis of six months or less to live.
• Patients who have decided to forego curative treatments in favor of comfort care.
• Symptoms might include chronic pain, difficulty breathing, severe fatigue, and emotional distress.

Preparation

• No specific preparation is required.
• Discussing goals of care and advance directives with family and healthcare providers.
• Patients might need certain exams or medical records to confirm eligibility for hospice care.

Procedure Description

1. Initial Assessment: A hospice team consisting of doctors, nurses, social workers, and chaplains assesses the patient's condition and needs.
2. Care Plan Development: A personalized care plan is created to manage symptoms and provide comprehensive support.
3. Service Initiation: Hospice care services begin, including regular visits by healthcare professionals to manage pain, medications, and other symptoms.
4. Ongoing Support: Continuous support for both the patient and family, including counseling and respite care if needed.

• Tools and Equipment: Medical supplies for pain and symptom management, comfort aids.
• Anesthesia or Sedation: Generally not applicable, but pain management may involve medications that require close monitoring.

Duration

Hospice care typically continues as long as needed, often until the patient's passing, or until the patient or family decides to discontinue services.

Setting

Hospice care can be provided in various settings:

• At the patient's home.
• Hospice centers.
• Hospitals.
• Long-term care facilities.

Personnel

• Hospice nurses
• Physicians
• Social workers
• Chaplains or clergy
• Hospice aides
• Volunteers

Risks and Complications

• There are minimal risks involved directly with receiving hospice care.
• Potential emotional distress for the patient and family as they deal with end-of-life issues.
• Managing complex symptoms might require careful adjustments of medications to avoid side effects.

Benefits

• Improved quality of life through effective pain and symptom management.
• Comprehensive support for emotional, social, and spiritual needs.
• Relief for family caregivers through respite care and professional support.
• Enhanced dignity and comfort for the patient in their final days.

Recovery

• There is no typical "recovery" as hospice care is for end-of-life support.
• Focus on maintaining comfort and quality of life.
• Ongoing support for families, including bereavement services after the patient's passing.

Alternatives

• Palliative Care: Aimed at symptom management but can be used alongside curative treatment.
  • Pros: Can begin at any stage of illness.
  • Cons: May not provide the comprehensive support that hospice care offers at end-of-life.
• Continuing Curative Treatment: Focus on trying to extend life by treating the disease.
  • Pros: Potentially longer lifespan if effective.
  • Cons: May involve aggressive treatments with significant side effects, reducing quality of life.

Patient Experience

• Patients may experience relief from chronic pain and symptoms due to comprehensive pain management.
• Emotional and spiritual support can help ease feelings of anxiety and fear.
• Hospice care teams often take measures to ensure comfort, including counseling and ensuring a peaceful environment for the patient and family members.
• Pain management is a priority, with medications and therapies adjusted to maintain comfort and dignity while minimizing side effects.