Will Hospice Shorten Your Life?

images-1Many of us might believe that when we choose to accept hospice care at the end of our lives, our lives will be shortened as a result. After all, hospice patients often stop painful chemotherapy or other interventions that are expected to prolong their lives.

But a number of studies have proven this not to be true. A landmark study from the Massachusetts General Hospital in 2010 made some startling findings. Researchers randomly assigned 151 patients with Stage IV lung cancer to two possible approaches to treatment. Half received the usual oncological care. The other half received the same oncological care with additional visits from a palliative care specialist. These specialists focus on preventing and relieving the suffering of patients.

Those who saw a palliative care specialist chose to stop chemotherapy sooner, entered hospice far earlier and experienced much less suffering at the end of their lives. And they lived 25% longer that those who did not receive palliative care!

Atul Gawande, M.D. ,in his groundbreaking book, “Being Mortal”, states that “Like many other people, I had believed that hospice care hastens death, because patients forego hospital treatments and are allowed high-dose narcotics to combat pain. But multiple studies show otherwise.”

He adds, “For some conditions, hospice care seemed to extend survival. Those with pancreatic cancer gained an average of three weeks, those with lung cancer six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer when you stop trying to live longer.”

Gawande, a practicing physican in Boston, reports that most terminally ill cancer patients have had no discussion with their doctors about their goals for end of life care despite being within months of death. But those patients who enrolled in hospice, suffered less and were better able to interact with others forlonger period of time. “People who had substantive discussions with their doctor about their end of life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.”


How to talk with Mom and Dad

Opening up a conversation with your elderly parents about important issues can often be a very stressful and difficult task. You know there are certain things you need to talk to them about but you often fear that they might speculate what your motives are. So how do you open up those conversations without embarrassing yourself and upsetting your parents?

First you must remember that one of their primary concerns ( according to David Solie in hs book, “How to Say it to Seniors” )is maintaining control of their lives. They don’t want to be told that they can’t drive anymore or that they have to move out of their house into a retirement community. Even if these choices are in their best interest they will be very reluctant to comply if they don’t feel that they have made the decision.

But you also need to know that you don’t want to wait until its a crisis to approach your parents. In my 30 years as a financial adviser to hundreds of families, I never saw things go well when families tried to make decisions after a loved one was already in trouble. These situations are fraught with emotion and people don’t often think very clearly when things are unraveling.

Now, while your parents are still healthy ( hopefully) plan out what issues you need to discuss with them before you approach them. Try writing them a letter expressing your concerns and thoughts. Don’t give them the letter but use it as tool to explore your own emotions. Narrow down your concerns to be as specific as possible. What are you anxious about? Enroll the ear of a friend or spouse and read your letter to them. Do they think your concerns are legitimate and worth discussing? Finally, listen to the letter as if you were your parents. Where do you think there will be resistance or stubbornness?

Once you know the focus of your conversation develop an ice breaking phrase that you can use  with your parents. Make sure your questions are open ended and leave room for them to express their opinions. For example,” Mom, recently one of my friends told me her mom was having difficulty keeping up with all the chores around the house. What do you think she should do?” Or, “Dad, can I get your opinion on a couple of things?” Or as simply as “Mom, can we talk?” One of my favorites was “ Dad, how are you enjoying those golden years?”

Your parents probably want to talk about the same concerns you have, but they just don’t want to upset you or mention things that are uncomfortable. They certainly don’’t want to be told what to do. But by easing into the conversation and creating an environment that is safe, you can eliminate a lot of stress for them and yourself. You’ll also give them the opportunity to age with dignity and peace of mind.