The recent passing of former First Lady Barbara Bush has shed light on the importance of hospice or comfort care, which is also known as end-of-life care. Although it can be a difficult decision to make, an expert at Baylor College of Medicine says keeping loved ones comfortable during their last days may be the best option to avoid painful and unhelpful interventions.
“Hospice care is a segment of palliative care. It is a service delivered to patients with chronic serious illness and distressing symptoms, regardless of life expectancy. It is focused on the quality of life of that person and his or her family,” said Dr. Ursula Braun, associate professor of medicine – geriatrics and director of Palliative Care at the Michael E. DeBakey VA Medical Center. “The objective of such therapy is to improve quality of life for both the patient and the family and caregivers to ensure they have the support they need, regardless if they are at home, a hospital or a nursing home.”
Hospice or end-of-life care focuses on providing patients with relief from symptoms of pain, physical stress, and mental stress of a terminal illness – whatever the diagnosis. The goal is to prevent or relieve suffering as much as possible while respecting the dying person’s wishes.
“Individuals may choose this care because the treatments have become overly burdensome. The person might feel that risks and burden outweigh the benefit or that the expected possible gain in life expectancy is not worth the loss of life quality by being in the hospital and undergoing painful procedures,” Braun said.
Some people, often older individuals, may feel they had a good life and don't want to spend the end in a hospital, preferring a natural death at home. “We are all mortal, and some diseases cannot be cured. Some people will choose this care when all options to cure or reasonable options at life-prolongation without significant loss of quality of life have been exhausted,” she added.
The decision to focus on end-of-life care versus continuing to seek medical treatments is understandably a difficult choice not only on the individual but also for the family. Although difficult, Braun advises family members to try to spend quality time with their loved ones during their last days.
“It is important to remember that end-of-life care is all about keeping loved ones comfortable, and by doing this you are avoiding painful and not truly helpful interventions. This is a good opportunity for the patient to achieve life closure by saying 'thank you, I'm sorry, I forgive you and I love you' to all the important people in one's life,” she said.
Discussing death and end-of-life care is uncomfortable and difficult. However, even at the end of life, you can continue to support and nurture your relationship with your loved one by simply being there for them, Braun said. When someone is imminently dying, the person will likely still perceive touch and might be able to hear – those are usually the last senses to go – even though they cannot respond back you can still touch them and talk to them. So being there, comforting them and supporting them can be an important source of strength and comfort for everyone, she said.