Challenges of Noncancer Patients Transitioning to Hospice

Abstract

The traditional model of hospice care based on the course of incurable cancer with rapid decline and death does not apply to chronic diseases. Cancer also may take a chronic course and no longer accounts for the majority of admissions to hospice. Hospice admissions now include a majority of noncancer diagnoses. The second challenge is the wide disparity between chronic disease courses. Case examples of people with different diagnoses demonstrate a variety of contrasting trajectories of illness. With ever-increasing advances in medical care, the indications for intensive treatments have never overlapped so much with the indications for hospice referral. This represents the third challenge. In addition, some treatments and medications that improve symptoms and quality of life may significantly prolong life, thus contradicting the traditional expectation of “foregoing life-sustaining treatment” in favor of enrolling in hospice. Finally, a description of various assessment tools helps in identifying the indications for hospice.