Journal of Palliative Medicine

How does being certified and re certified for hospice care effect the experience of these stages?…Research shows that acceptance (if your training for end-of-life care facilitated that) is key to being appropriate and effective in encounters involving end-of-life and bereavement. Once a clinician has no fixed point of view about dying and death, they are able to more easily identify and meet patient and family needs. So, yes…it makes a huge difference.

Over the years I’ve found patients (not always family members) to have arrived at acceptance before death. Sometimes they come to hospice and pallative services needing to go a little further before acceptance or allowance takes it’s place…and therefore clinicians play an important role in completing…so *if* the clinicians in hospice are skilled and accept dying themselves…some don’t; they can help patient and family get to the truth of it and then do what they would do once they accept that it’s happening. I’ve never seen a patient believe they are not going to die – in fact, give them a glowing prognosis (mostly not true) and they still know that they’re dying. People know these things. It’s our job as clinicians is to help them know what they already know. But we don’t do that very well : / We can though!

Patients realize that medicine is not as an exact science as many want to think! Clinicians give their best advice based on their knowledge and experience, yet sometimes things turn out differently. So, giving them what you see is always best, and then the rest we basically respond to as it comes. Worrying about when or if they go through certain stages is not productive, yet being aware is helpful if they do enter the stages.

There is so much confusion out there between palliative acre and hospice that confusion should probably be a stage
I think that having hospice allows my patients to experience the stages with a compassionate group of people, and that has to help somehow.