The Hospice Transition: How Medications Change
The transition of a patient from curative care to palliative or hospice care brings changes in treatment philosophy. One of those involves medications.
A terminally ill patient has likely been taking an ever-increasing quantity of life-extending drugs, perhaps for years. It is part of the progression of the disease. With the transition to hospice, those drugs must be re-evaluated along with the patient’s and family’s goals of care.
Hospice Meds Address Symptoms, Not the Disease
Hospice physicians use meds in a different way, addressing symptoms, not the disease process. As such, they are very comfortable using relief medications—like morphine—more aggressively than a referring physician would.
Just as the referral physician adjusts the meds as the patient’s condition progresses, the hospice doc adjusts meds as well, but in the opposite direction. As death approaches, the patient’s metabolism changes; the need for medication naturally reduces.
As VITAS Healthcare Regional Medical Director James Wright, DO, says, “The difference is in scope and objective: medications can’t and shouldn’t remain the same.”
Reassuring Patients About a Change in Meds
Reduced meds can be a cause for concern for a hospice patient. The administration of fewer and milder drugs requires more communication, specifically on the part of the referring physician, who presumably has been caring for the patient for a significant duration of the illness.
Hospice physicians are available to consult with a referring physician who wants to follow their patient through the hospice transition. But because hospice happens in the home, many referring physicians turn day-to-day care over to the hospice team rather than add house calls to an already over-scheduled day.
Patients seeing a new physician and learning of a change in medications worry that their physician is “giving up” on them or that they are no longer worthy of intensive care. They need to be reassured that neither is true.
In fact, transitioning to hospice means transitioning away from clinically demanding and expensive medications. The results are simpler for the patient, with less symptom burden, fewer side-effects, more comfort and more dignity.