Care Decisions in the Final Weeks, Days, and Hours of Life
Key Points for This Section
Decisions about Chemotherapy
Decisions about whether to continue or stop chemotherapy are made by the patient and doctor together. About one-third of patients with advanced cancer continue to receive chemotherapy or other treatment near the end of life.
Treatment with chemotherapy at this time can result in the following:
- Serious side effects.
- Spending more days in the hospital.
- Spending last days in an intensive care unit.
However, some patients with cancer choose to continue chemotherapy because they feel it helps them to live in the present and focus on active treatment. Other patients choose palliative or comfort care to treat pain and other symptoms. These decisions are based on the patient's goals of care and the likely risks and benefits of treatment.
Decisions about Hospice
Hospice care is an important end-of-life option for patients with advanced cancer. Patients may feel that beginning hospice care means they have given up. Some patients fear losing the relationship with their oncologist. However, many patients and caregivers feel they receive important benefits from hospice care.
Patients who receive hospice care seem to have the following:
- Better mental outlook.
- Better relief of symptoms.
- Better communication.
- Less stressful death (without causing death to happen sooner).
Hospice-related services include:
Doctors, patients, and caregivers should discuss hospice care and when it should begin.
When hospice benefits are covered by Medicare, physicians are required to certify that patients are not expected to live more than 6 months and that patients are not being treated to be cured. Other policies may be different, depending on the hospice and the state.
Decisions about Place of Death
Many patients with advanced cancer wish to die at home. Patients who die at home with hospice services and support seem to have better symptom control and quality of life. They also feel better prepared for death than patients who die in a hospital or intensive care unit. Grieving caregivers have less trouble adjusting to their loss and feel they have honored the patient's wishes when their loved one dies at home.
Patients who get hospice care are more likely to be able to die at home. Hospice care can help control the patient's symptoms and give the caregiver the help they need.
However, not all patients choose to die at home. It is important for the patient, caregivers, and doctors to discuss where the patient wishes to die and the best way to fulfill the patient's decision.