If physicians or specialists do not feel comfortable with these difficult-but-rewarding conversations, trained VITAS facilitators are always available to meet with patients and families—wherever they are and whenever they are ready to decide the course of their care as their health declines.

VITAS Can Help You Educate Your Patients

Just as we can help physicians overcome their unease or perceived lack of training to engage in goals-of-care conversations, we can help patients overcome their concerns about the transition to hospice care, by:

• reassuring patients that hospice care does not mean giving up the medications or treatments (e.g., inhalers, access to a respiratory therapist) that currently provide comfort and symptom management
• explaining the value of the interdisciplinary hospice team to address physical, emotional, and spiritual needs
• offering an individualized care plan and one of four levels of hospice care to meet their individual needs and goals
• adjusting medication delivery seamlessly as their symptoms worsen to maintain comfort (e.g., switch from inhaled medication to nebulized versions in the home)
• delivering the necessary equipment, medications, and supplies directly to them, wherever they prefer to receive care, usually at a cost saving
• easing the concerns of anxious family members and caregivers through regular team visits, training, educational materials, and 24/7 availability of VITAS clinicians to manage crises and keep their loved one comfortable

Goals-of-Care Conversations Should Be Commonplace

Our goal is to support our healthcare partners in private practices, specialty practices, hospitals, and care facilities. We want them to embrace a 360-degree view of advanced disease so that they know when it’s time to call VITAS for a goals-of-care conversation. Ideally, suggesting a GOC conversation should be as commonplace in a clinician’s daily routine as taking vital signs, interpreting laboratory findings, and exploring treatment options, particularly for those with advanced illness.

What are signs of hospice eligibility in a patient with advanced lung disease?

• A “no” answer to the “surprise question”: “Would you be surprised if this patient were to die in the next year?”
• Shortness of breath at rest or with minimal exertion
• More than 50% of waking hours spent sitting or resting (Palliative Performance Scale of about 50%)
• More dependence for activities of daily living
• Functional decline over time

We know that talking with patients about their disease and wishes is one of the hardest—and most important—activities that healthcare professionals can undertake, especially for patients with advanced illness.

Just as our hospice care teams and on-call clinicians are available 24/7/365 to provide end-of-life care, our trained physicians, nurse practitioners, and social workers are always available to start the conversation about the transition to comfort-focused care.