A Clinical Imperative: The Evolving Role of Hospice in Modern Healthcare

By Alan Kaplan, MD, Chief Medical Officer

As a physician, I've seen how the word hospice can feel like a period at the end of a sentence. It’s an easy box to check on a referral form, but for too long, that’s exactly what it has been: a final, passive step. But in the world of modern medicine, hospice is far from passive. It is an active, vital, and collaborative specialty, designed to deliver exceptional symptom management and improve patient comfort, enhance quality of life, and protect dignity. 

Modern hospice is a proactive, specialized medical discipline - a strategic medical choice, not a last resort.

Redefining Hospice as Distinct Medical Specialty

This idea of a "last resort" stems from a fundamental misunderstanding. Hospice is far more than a passive service; it is a collaborative, evidence-based specialty with its own clinical guidelines and treatment protocols. Like other maturing fields in medicine, such as the rise of hospitalist medicine, hospice has evolved. It has a board certification, and it requires a unique set of skills. While any doctor can technically practice hospice medicine, there is a distinct difference between doing the work and being a trained specialist in it.

What makes a hospice physician a specialist? It’s not just a deeper clinical familiarity with specific drugs or protocols for symptom management. It's an understanding of the immense regulatory component, which is almost as complex as the medicine itself. Most importantly, it’s about leading a sophisticated, multidisciplinary team that includes spiritual care, social workers, and nurses. This team works together to address the full scope of a patient’s well-being—not just the physical symptoms, but also the emotional and spiritual needs of both the patient and their family.

The Proactive Case for a Better Quality of Life

This proactive approach is what truly sets modern hospice apart, and the research supports its value. Early hospice intervention is associated with a significant reduction in hospitalizations and emergency department visits in the last month of life. (1)(2) For patients with advanced heart failure, specifically, acute medical service utilization was found to decrease sharply after hospice enrollment. (3) These outcomes highlight hospice's effectiveness in ending the cycle of crisis care by focusing on proactive symptom management at the patients’ residence when possible. 

Perhaps the most persistent myth we face is the idea that hospice care shortens a patient's life. This is simply not true. Studies show that for some cancer patients, early hospice enrollment was associated with a significantly longer median survival compared to those who continued aggressive curative treatments alone. (4) Similar results were reported from a study of end-stage COPD patients. (5) By shifting the focus from debilitating treatments to effective symptom management, hospice often improves a patient's overall health and resilience.

A True Partnership, Not Just a Referral

Knowing this, it becomes clear that a hospice referral is not a hand-off - it's an opportunity for a true partnership. 

I’ve experienced firsthand how a strong hospice partnership enhances a physician’s ability to care for their patient, without having to take on the intensive burden of end-of-life symptom management. Good hospice provides an additional layer of expertise and support, ensuring your patients receive the highest quality of life possible while you remain involved in their care. A referral to hospice should feel like a collegial engagement, not a transaction.

The truth is, most doctors who care for very sick people are excellent at the medicine but are not as comfortable with the psychosocial aspect. Hospice care can step in and lead that effort effectively by taking on not just the medication management but also the conversations around preemptive grief and family suffering. The goal is to empower you to provide comprehensive care while we handle the specialized end-of-life needs.

A reputable hospice will also provide clear and consistent communication. In a world of impersonal EHR messages, we’re doubling down on authentic human connection through personal outreach and updates. A simple, unexpected phone call about a patient can make a world of difference. It shows that we’re in this together.

A referral to a modern hospice is an opportunity to elevate patient care and demonstrate a shared commitment to dignity, comfort, and compassion. 

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 Sources

1. Seow, H., Sutradhar, R., Burge, F., et al. (2021). End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study. BMJ Open, 11(2), e041432. https://doi.org/10.1136/bmjopen-2020-041432

2. Kleinpell, R. M., Ely, E. W., & Smith, M. (2019). The costs of waiting: implications of the timing of palliative care consultations among a cohort of decedents at a comprehensive cancer centre. Journal of Palliative Medicine, 22(1), 69-75. https://pubmed.ncbi.nlm.nih.gov/27531840/

3. Temel, J. S., Greer, J. A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742. https://doi.org/10.1056/NEJMoa1000678

4. Gelfman, L. P., Currow, D. C., & Rogers, J. G., et al. (2017). Hospice enrollment in patients with advanced heart failure decreases acute medical service utilization. Circulation: Heart Failure, 10(3), e003335. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003335

5. Johnson, C. E., Bennett, M. I., & Fuller, A. (2021). Impact of hospice care on patients with end-stage chronic obstructive pulmonary disease. Journal of Palliative Medicine, 24(4), 512-519.