Hospice Admission Criteria for Terminal Cancer Patients

Terminal cancer patients

Hello, Dr.
Chen.
I would like to inquire about the criteria for admission to a palliative care unit.
My father has been diagnosed with terminal cancer by a physician at Tzu Chi Hospital in Taipei, with an estimated lifespan of about 3 to 6 months.
He is suffering from severe pain due to cancer, and even pain patches are ineffective.
However, the physician insists on continuing chemotherapy and states that my father can only be admitted to the palliative care unit if he is in a coma.
As a former healthcare professional, I find this situation to be quite different from my previous understanding.
Could you please briefly explain the admission criteria? Thank you.

Dan You De Nu Er, 30~39 year old female. Ask Date: 2009/05/07

Dr. Chen Sirong reply Oncology

Hello, the admission criteria for a palliative care unit are as follows: patients with terminal cancer who experience physical discomfort (such as pain, shortness of breath, vomiting, etc.) that cannot be managed in an outpatient or home care setting.
Based on your correspondence, it seems appropriate for palliative care.
I recommend directly consulting with the physician in charge of the palliative care unit at the hospital.
Wishing you peace and health.
Sincerely, Dr.
Kao Chung-Shu, Attending Physician, Department of Oncology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2009/05/07

More Info

Understanding the criteria for hospice admission is crucial for families dealing with terminal illnesses, particularly cancer. Hospice care focuses on providing comfort and support to patients with a life expectancy of six months or less, prioritizing quality of life over curative treatments. It is essential to recognize that hospice care is not solely for patients who are in a comatose state; rather, it is designed for individuals experiencing significant distress due to their illness.

In your father's case, where he has been diagnosed with terminal cancer and is experiencing severe pain, it is important to understand the criteria for hospice admission. Generally, the following conditions must be met for a patient to qualify for hospice care:
1. Terminal Diagnosis: The patient must have a terminal illness, which is typically defined as a condition that is expected to lead to death within six months. This prognosis should be made by a qualified healthcare provider.

2. Symptom Management Needs: Patients should be experiencing symptoms that are difficult to manage through standard medical care. This includes severe pain, nausea, shortness of breath, or other distressing symptoms that significantly impact the patient's quality of life.

3. Patient and Family Goals: The decision to enter hospice care should align with the patient's and family's goals. If the focus is on comfort and quality of life rather than aggressive treatment, hospice may be the appropriate choice.

4. Refusal of Curative Treatment: While hospice care does not require patients to refuse all treatments, it is generally expected that patients will not pursue aggressive curative measures, such as chemotherapy, which can prolong suffering without significantly improving quality of life.

In your father's situation, the insistence on continuing chemotherapy despite his severe pain may be a point of contention. It is crucial to have an open dialogue with his healthcare team about the goals of care. If the chemotherapy is causing more harm than benefit, it may be time to discuss transitioning to hospice care, which can provide comprehensive pain management and support.

If the current medical team is resistant to hospice admission, consider seeking a second opinion from a palliative care specialist. These professionals are trained to assess the needs of patients with serious illnesses and can advocate for hospice care when appropriate.

Additionally, hospice care can be provided in various settings, including the patient's home, hospice facilities, or even hospitals. The choice of setting should be based on what is most comfortable for the patient and family.

In summary, hospice care is an essential resource for patients with terminal cancer who are experiencing significant distress. The criteria for admission focus on the patient's prognosis, symptom management needs, and alignment of care goals. It is vital to communicate openly with healthcare providers and advocate for your father's needs, ensuring that he receives the compassionate care he deserves during this challenging time.

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