May 16, 2023
5 Questions with Dr. Mouser: What's the Difference Between Hospice and Palliative Care?
Palliative care and hospice are two options that can help patients and their families navigate a diagnosis like cancer or other serious condition. Both services are dedicated to enhancing quality of life and managing pain, but there are some key differences.
Q: Would you explain what hospice is and is not?
Dr. Mouser: Hospice is a very robust program, covered by Medicare and private insurance, which provides intensive, multidisciplinary team-based care wherever someone calls home. Hospice is for someone who has been identified to mostly likely be in their last six months of life.
What is very sad and sometimes disheartening is that people run away from hospice because naturally, nobody wants to die. There is a misconception that when you elect hospice, you're ready to die, or that you’re giving up and resigning to die. There is even a mistaken belief that hospice expedites dying. None of these are true.
Q: Can you clear up these mistaken beliefs about hospice?
Dr. Mouser: First, hospice is not “giving up.” The reality is hospice care is aggressive medical treatment. In fact, the kinds of treatment we provide in hospice are usually more aggressive than in the hospital. It’s common for me to get calls from hospitals asking me to intervene because what they’re doing isn’t working — the patient’s quality of life is very poor and they are heading towards end of life. The high-quality palliative care provided in hospice helps pull them out of that tailspin to the point that they are stabilized and able to enjoy a much higher quality of life so they can enjoy each day to the fullest.
Secondly, hospice does not hasten death. Patients with serious illness and chronic disease who enter hospice often live longer than an individual in the same situation who is undergoing aggressive treatment. Those aggressive disease treatments often backfire and shorten life, and certainly worsen quality of life. A patient who chooses hospice care often wants to put all the marbles in quality of life, because they're not living well — they're alive and not living well. In hospice care, they're able to realize much better quality of life and decide they'd like to [be discharged from hospice care and] try treatment again. Sometimes that's because they're strong enough to undergo treatment that they weren't previously eligible for, a new treatment becomes available, or a transplant becomes available.
Q: How does hospice care differ from palliative care?
Dr. Mouser: Palliative care is a medical subspecialty very much like other subspecialties, like a cardiologist. The difference is a cardiologist focuses more narrowly on the organ of the heart and all of the diseases that can impact the heart. And when they get consulted, they're only focused on what's going on with the organ of the heart. And so as one becomes more ill, they often will have numerous subspecialists involved for each organ that's failing, a kidney doctor and a heart doctor and a lung doctor all at the same time.
But what can happen is in everyone's tunnel vision to the disease of that organ, sometimes the big picture of how it's impacting the patient and their quality of life is lost. Their primary focus is to help restore organ function.
In palliative care, our training is to take a step back and to put all of the pieces together. There are two aspects a palliative care provider is focused on. The first is symptom management — making sure all of the burdens of suffering from the effects of the disease are addressed. The second focus is care navigation, which involves making sure the patient has a good understanding of what we expect to occur going forward and the different treatments available. The patient is given the pros and cons of treatment, and things to strongly consider so they are never left with a sense of “I wish I had known this earlier, because I might have made a different decision.”
Not all patients who need palliative care qualify for hospice care; however, there are many times people who need intensive palliative care and do qualify for hospice don't find out until it is very late in the course of their illness.
Palliative care is focused on care planning, care navigation and symptom management. Hospice care additionally provides a robust multidisciplinary team with the ability to provide for the levels of care that hospice enables.
Q: Besides the patient, who benefits from hospice care?
Dr. Mouser: Caregivers, most certainly. Caregiver breakdown occurs when family members are the primary caregivers and their loved one is suffering. They don't know if they're making the right decisions. They don't know if they're giving medications correctly. They don't have access to people coming to help them with just a phone call. Hospice care brings incredible power and peace of mind to the family, but also to the patient. Often, a patient feels like a tremendous burden. Not only do they feel like they're not living well, but they feel they are hurting the people they love the most because they're a burden. To replace all of that with a highly trained team of individuals who can come in and bridge those gaps and help bring guidance and clarity, and education and care support, is often a priceless decision.
Q: Any last thoughts?
Dr. Mouser: I think sometimes the easiest way to think about hospice is you are amplifying the resources the palliative care team has. Hospice care provides additional resources to send doctors, nurses and aides, spiritual care counselors and social workers to wherever the patient calls home on regular basis, and with the insurance benefit.
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Dr. Thomas Mouser, MD, is chief medical director with EveryStep. He is dually board certified in internal medicine and palliative care, having completed his residency at University of Iowa – Des Moines and a fellowship at Stanford University. Dr. Mouser has spent countless hours at the bedside of those with serious illness and chronic disease. In his role, he helps hospice, home care and palliative care patients and their families navigate complex medical decisions as guided by the patient’s goals of care. Dr. Mouser’s fellowship training provided for an expertise in advanced symptom management and communication when working with those with high burdens of suffering. He is passionate about helping his patients reach their best quality of life so they can live life to the fullest.