Hospice can be a difficult subject to approach for patients, families and medical people. As a result, physicians are reluctant to bring it up because of concern over a patient's reaction. Families are often reluctant to ask for fear of offending the physician.

Families who have had a loved one in the care of Alive Hospice often comment that they wish they had started hospice services sooner.

If patients are to get this marvelous benefit for a longer period of time, it would be useful to know when to start thinking of hospice. It is reasonable to think about hospice any time the benefits of life-prolonging treatment seem to be outweighed by the burdens.

Questions that are helpful in talking with one's doctor about care options include:

• What is the likelihood of a life-prolonging treatment working?

• How long will it work?

• What are the side effects?

• What would things be like without treatment?

In answering these questions, physicians take into account such issues as what percentage of patients actually respond to treatment; how long the response may last; and what kind of response an intervention can produce. Burden can include not only cost, but side effects from the treatment; what is involved in receiving the treatment; and considerations for getting to and from the treatment.

Whether these issues are acceptable is a decision for the patient or the patient's surrogate.

At the point where the benefits may not justify enduring the burdens, consideration should be given to stopping the treatment. A patient is eligible for hospice services if the likely strength of survival is six months or less. A physician who believes this is the case may suggest hospice care.

What's often overlooked, and what many people don't realize: A patient can suggest hospice care to his or her physician, too.

For more information about Alive Hospice, including frequently asked questions, please visit http://www.alivehospice.org. To contact Alive Hospice, call 615-327-1085.