Palliative Care and Hospice: Advancing the Science of Comfort, Affirming the Art of Caring

  • Martha L. TwaddleEmail author


These scenarios of late hospice referrals were my steady diet in the early years of this work and sadly, they even occur today. The median length of stay for patients utilizing the Medicare Hospice Benefit is still hovering around 21 days (2010 Edition of NHPCO facts and figures: Hospice care in America. Physicians not understanding the full purpose of hospice, coupled with the tendency to wait until the prognosis is clearly end-stage, delay assessments for hospice such that they are “brink of death” referrals (Cancer 94:2733–2737, 2002; Rescuing the end-of-life from the medical system, St. Martin’s Press, New York, 2006). In the 22 years that I have done this work, families have repeated the mantra of “why didn’t we have this sooner; where were you 6 months ago?” even as the physicians say, “They aren’t ready for hospice yet!”


palliative care hospice biopsychosocial model hospice and ­palliative medicine science of comfort end of life quality of life 


  1. 1.
    Edition of NHPCO facts and figures: Hospice care in America. Accessed February 22, 2011.
  2. 2.
    Lamont EB, Christakis NA. Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer. 2002;94:2733–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Kiernan SP. Rescuing the end-of-life from the medical system. New York: St. Martin’s Press; 2006.Google Scholar
  4. 4.
    Christakis NA, Escarce JE. Survival of Medicare patients after enrollment in hospice programs. N Engl J Med. 1996;335:172–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Connor SR, Teno J, Spence C, Smith N. Family evaluation of hospice care: results from ­voluntary submission of data via website. J Pain Symptom Manage. 2005;30:9–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Connor SR, Tecca M, LundPerson J, Teno J. Measuring hospice care: The National Hospice and Palliative Care Organization National Hospice Data Set. J Pain Symptom Manage. 2004;28:316–28.PubMedCrossRefGoogle Scholar
  8. 8.
    Christakis NA, Iwashyna TJ. The health impact of healthcare on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses. Soc Sci Med. 2003;57:465–75.PubMedCrossRefGoogle Scholar
  9. 9.
    Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356:469–78.PubMedCrossRefGoogle Scholar
  10. 10.
    History of the American Academy of Hospice and Palliative Medicine. Accessed February 22, 2011.
  11. 11.
    Nelson R. Palliative care programs continue to increase in American hospitals. Accessed February 22, 2011.
  12. 12.
    Center to Advance Palliative Care. Accessed April 3, 2011.
  13. 13.
    Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306:639–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Gade G, Venohr I, Conner D, et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med. 2008;11:180–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Midwest Palliative and Hospice Care CenterGlenviewUSA

Personalised recommendations