An honest discussion of what is likely to be gained and what the side effects of treatment are likely to be is the best course of action. This understanding can be fostered by direct and forthright discussions regarding prognosis and benefits and risks of therapy and is enhanced by a trusting physician-patient relationship. Involvement of hospice services early in the course of palliative care can be helpful. The financial benefits alone of switching to the Medicare hospice benefit may be substantial. Hospice personnel have expertise in preparing patients and families spiritually, financially, and legally for the end of life.
Most patients wish to remain at home.
Every effort should be made to accommodate this wish, but attention needs to be paid to caregiver burden. Short stays in a hospital or nursing home, which are covered by Medicare, may be necessary for respite to caregivers. Interventions and clinic visits should be kept to the minimum necessary for palliation. Although Medicare reimburses physicians for time spent on hospice issues, the reimbursement is rarely adequate and does not compensate for the amount of documentation required. All rights reserved.