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letters | The challenge of end-of-life care

Delays in hospice referral can do harm

The PBS Frontline special “Being Mortal” examined how doctors help terminally ill patients prepare for death.Courtesy of FRONTLINE

DR. ANGELO E. Volandes’ article “End-of-life care needs an overhaul” (Op-ed, April 15) did a noble job of illustrating the compelling issues surrounding this complex and emotional time. At NVNA and Hospice of Norwell, we see much of what Dr. Volandes wrote about — patients and families often have difficulties making their wishes about end-of-life care known. Oftentimes, they make decisions far too late to benefit from hospice care instead of more invasive treatments at hospitals.

We have seen a decline in the length of hospice stays and an increase in the number of patients being discharged from hospitals for a short stay at a hospice before death. The result is that essential relationships between professional care staff, hospice nurses, and patients and their families can’t be developed to provide the physical and emotional support needed at the end of life.


Two issues that are important to consider during this time are an appropriately timed discussion about end-of-life with the patient, and the quality of hospice care delivery. Ideally, the patient’s primary care physician – who often has the longest relationship with the patient – will have the end-of-life conversation in a timely manner. This takes education and practice, but ensures there is time to answer the questions mentioned in the article, ultimately providing for assurance that patients’ goals and wishes will be honored.

As Dr. Volandes points out, most patients want to be treated at home. Sometimes this is not possible and a hospice residence is a better option than a hospital. When there is a delay in referring to hospice, the quality of care delivery is affected. Symptoms are still expertly managed, but again, when relationships aren’t established and discharges and referrals are crisis oriented, families are often left with feelings of anger and staff members feel disappointment.


Hospice is not a place or simply a provision of service at the end of a person’s life, but rather a philosophy of care that offers patients and their families the chance for a more comfortable and safe end-of-life experience.

Meg Doherty RN

The writer is CEO of NVNA and Hospice in Norwell.