"A User-Friendly Guide to End-Of-Life Care" by Joan Teno, MD

This article is more than 12 years old.

As a physician practicing in Rhode Island, I have watched the rapid growth of hospice programs locally. A similar trend has occurred across the USA.

An increase in number of hospice programs is important to expanding access to hospice for seriously ill persons and their families. However, it is important that these newer programs, many of which are “for-profit,” deliver high-quality care that focuses on the unique needs of dying persons and their loved ones. My research based on interviews with family member about their perceptions of the quality of hospice shows that reported concerns, unmet needs, and satisfaction vary by hospice programs.

Doctors, patients, and family are now faced with an important decision at one of the most trying time periods.

In the JAMA series, “Perspectives on the Close of Life,” Steve Connors and I were given the opportunity to help a primary-care physician choose which hospice program would be best for a patient. Unfortunately, information on the quality of hospice care is not publicly available.

Hospice Care: A Consumer's Guide to Selecting a Hospice Program (PDF)

In the Feb. 11 JAMA, based on existing guidelines and the National Consensus Project, we outline expectations and questions to determine whether a hospice program is striving for excellence. The keys to high-quality care are: 1) Competent care by an interdisciplinary team; 2) care that is centered on patient and the family needs; 3) Coordinated care; 4) Compassionate care; and 5) care that is committed to quality through ongoing monitoring.

We formulated a series of questions the primary care provider or consumer can ask of hospice programs to help identify quality hospice programs. These questions and a brochure created by the National Hospice Foundation can be found here.

Dr. Joan Teno is a professor of community health at The Warren Alpert Medical School of Brown University.

This program aired on February 11, 2009. The audio for this program is not available.

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Martha Bebinger covers health care and other general assignments for WBUR.