Prognostication

Several signs and symptoms indicate that a patient is medically appropriate for hospice care. In general, hospice patients are thought to have six months or less to live if a disease takes its naturals course. Only a doctor can make a clinical determination of life expectancy. However, look for these signs that the disease has progressed to a point where all involved would likely benefit from hospice care.  

Referral Triggers

  • Uncontrolled or chronic symptoms that interfere with quality of life
  • Progressive decline in functional capability
  • Unintentional, progressive weight loss greater than 10 percent in the past six months
  • May have multiple chronic comorbidities
  • Dependence on assistance for most cares
  • Recurrent infections
  • Recurrent ER visits or hospitalizations
  • Non-healing wounds

Each illness has its own indicators. Click on each disease to see signs of decline, and if you have a patient who exhibits these signs, please contact us for more information about starting hospice services or learn how to refer a patient to hospice care. Please use this information as a guide. 

Advanced Cardiac Disease
  • Optimally treated for heart disease or CAD, is not a candidate for surgery or refuses recommended surgery
  • Patients with CHF or angina should meet criteria for New York Heart Association (NYHA) Class IV
  • Patients can be NYHA Class III if significant comorbidities
  • Comorbidities may include COPD, renal disease, liver disease, dementia, diabetes, Parkinson’s, etc. 

Advanced Pulmonary Disease
  • May include pulmonary fibrosis and pulmonary hypertension
  • Disabling shortness of breath while at rest; even talking may cause shortness of breath
  • Decreased functional capacity, as evidenced by bed-to-chair existence, fatigue or cough
  • Recurring or exacerbation of pneumonia
  • Right Heart Failure (RHF) second to the pulmonary disease
  • Unintentional, progressive weight loss greater than 10 percentof body weight in the past six months
  • Resting tachycardia greater than 100/minute
  • Hypoxemia at rest on room air 

Stroke
  • Unable to care for self
  • Unable to maintain hydration and caloric intake 

Cancer
  • Advanced, recurrent or metastatic cancer
  • No curative treatment being sought
  • Palliative radiation or chemo considered on an individual basis 

Advanced Dementia
  • Progression of the dementia
  • Requires assistance for ambulation, dressing and bathing
  • Urinary and bowel incontinence
  • Speaks six words or less, no consistent meaningful conversation
  • Unintentional, progressive weight loss greater than 10 percent of body weight in the past six months or albumin level less than 2.5gm/dl
  • Recurrent infections, such as pneumonia, UTI or pressure ulcers
  • Frequent falls 

Advanced Renal Disease
  • Patient cannot be on dialysis
  • Serum creatinine greater than 8mg/dl (6mg/dl for diabetics) or creatinine clearance less than 10cc/min (<15cc/min for diabetics)
  • Existing comorbidities: COPD, heart disease, advanced liver disease or any malignancies
  • Advanced Liver Disease
  • Ascites not responsive to treatment
  • Serum albumin less than 2.5gm/ml
  • Hepatic encephalopathy not responsive to treatment
  • Hepatorenal syndrome
  • Additional factors: progressive malnutrition and muscle wasting, active alcoholism, hepatitis B positive, hepatitis C not responsive or not a candidate for interferon, or patient noncompliance 

ALS
  • Critical impairment of breathing capacity or ability to swallow
  • Rapid progression of ALS with nutrition impairment
  • Rapid progression with complications, such as repeated infections
 
Your patients may have priorities and goals aside from living longer.

Talk with your patients about their health goals, fears and trade-offs of treatment. To help you determine if it’s time to recommend hospice care, ask your patients the following questions:

    1. What is your understanding of your health or your condition?
    2. What are your goals if your health worsens?
    3. What are your fears?
    4. What trade-offs are you willing to make and not willing to make?

We can help you determine if your patient qualifies for hospice care, or broach the topic with your patients. Call us at (800) 237-4629 to discuss hospice eligibility for your patient, or refer your patient to Hospice of the Red River Valley online.

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