Patient/caregiver engagement is key to successful hospice outcomes. Engagement begins with expert communication based on an understanding of health literacy and adult learning principles. Information sharing and support of patient/caregiver participation in identifying treatment preferences that impact the patient/caregiver experience of care are not only central to hospice philosophy but are now a part of hospice quality reporting. Discussion of end of life preferences has been under utilized, often resulting in more aggressive treatment that generates worse quality of life for patients. Successful engagement can only be developed when it is based on collaboration, dignity and respect. The National Consensus Project (NCP) describes best practice for providing patient centered care consistent with patient preferences, “The patient’s goals, preferences and choices are respected within the limits of applicable state and federal law, within current accepted standards of medical care, and form the basis for the plan of care.

Why Treatment Preferences?

• Seriously ill and dying patients who are given the opportunity to express their preferences regarding life-sustaining treatment are more likely to receive care consistent with their values, improving patient and caregiver outcomes, including greater satisfaction with care. (CMS 2014).
• CMS now requires hospices to initiate a discussion with patients or caregivers about spiritual beliefs/existential concerns within five days of admission.

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