The Hospice Experience

A Holistic Approach to Care

Hospice care is designed to ensure that a patient experiences a peaceful, dignified, pain-free journey in a setting of their choice during their final months or weeks of life. This is achieved by addressing the four major domains of suffering for those with terminal, acute or chronic diseases, namely:

• Physical – the bodily pain caused by illness
• Psychological – the depression, anxiety and/or agitation that stem from illness
• Social – the changes that occur within relationships during progressive illness
• Spiritual – the questions that arise regarding the meaning of life, the patient’s legacy and the “why” of dying

“The idea behind hospice is to promote comfort, growth and development at the end of life,” explained Dr. Alexander Peralta, chief medical director at Faith Presbyterian Hospice and the T. Boone Pickens Hospice and Palliative Care Center. “Nobody had created a clear template for doing that in the medical environment prior to the establishment of hospice care.”
The term “hospice” has its roots in hospitality, with the original meaning used to describe European inns where travelers would receive meals and accommodations before resuming their journeys. That basic concept of hospitality was carried over when “hospice” was modified to encompass end-of-life care in the late 60s and 70s.
“Hospice is a gift to humanity because it involves intensive human caring at a difficult time in the illness trajectory,” added Dr. Peralta. “Everyone eventually dies, and we all deserve to receive the best holistic care possible as we endure that final stretch of life. Hospice is vital because it caters to a shared human experience. It’s not just for a select few.”

The Hospice Team

To ensure effective physical, psychological, social and spiritual care in accordance with a patient’s and their family’s needs, hospice relies on an interdisciplinary team of both medical professionals and support personnel. A typical hospice team is comprised of a:

• Registered nurse and licensed vocational nurse
• Nurse
• Physician
• Certified nurse assistant
• Medical social worker
• Chaplain
• Bereavement counselor
• Volunteers

Dr. Peralta explained that each of these professionals plays a unique, crucial role in ensuring a patient’s and their family’s needs are catered to.
“Hospice differs from many other medical specialties that mainly focus on pain and symptom management,” said Dr. Peralta. “It’s not just a doctor that’s managing the care. We have a diverse team in place that goes well beyond traditional-based medicine, which helps optimize and personalize the care we provide.”

Palliative Care and How It Relates to Hospice

Palliative care is an approach to medicine that not only supports a patient’s medical needs, but encompasses every other aspect of their life. It aims to relieve suffering while taking into consideration the values, beliefs and culture of patients and their families. It also supports the family’s wishes throughout the illness and in the event of death. An example of palliative care is when cancer patients forego sole aggressive medicinal treatment, and instead combine both medicine and supplementary treatments such as psychotherapy to help cope with the symptoms, side-effects and emotional toll of illness.

Both palliative care and hospice provide comfort, but differ regarding when they’re administered to patients. Palliative care can begin at diagnosis and is administered along with curative treatment. Hospice care is a subset of palliative care that begins after an illness is deemed terminal and curative treatment is discontinued.
According to Dr. Peralta, hospice and palliative care give medical and support personnel sufficient avenues to provide information that patients and their families can use to make critical and ethical decisions regarding life-sustaining care.

“We have the unique opportunity to sit down with patients and their families and have difficult discussions,” said Dr. Peralta. “We work to understand what they’d like their care to look like from a physical standpoint and beyond. We also have the opportunity to explain the diagnosis and prognosis, as well as walk them through every step of the care process.”