Hospice care is a specialized approach focused on providing comfort and support for individuals with a terminal illness, generally defined as having a prognosis of six months or less. When a patient in hospice develops an acute infection like pneumonia, a common concern arises about the course of action. Unlike traditional medical care, hospice does not aim to cure the underlying terminal condition, but it does manage acute symptoms. The approach taken with pneumonia prioritizes the patient’s comfort and quality of life above all else.
Understanding the Goals of Hospice Care
Hospice care involves a foundational shift in the approach to medical treatment. The primary goal transitions from curative intent, which seeks to eliminate the disease, to palliative intent, which focuses on relieving suffering and improving the quality of life remaining. This distinction is fundamental because aggressive treatments can often be burdensome and painful, potentially decreasing the patient’s comfort.
A terminal illness diagnosis means the body is frail and unable to recover from the core disease process. Introducing aggressive interventions, such as intubation or intravenous antibiotics, may not change the final outcome and can instead cause distress. Life-prolonging measures are avoided if they compromise dignity and comfort. Hospice provides a dedicated interdisciplinary team trained to support the physical, emotional, and spiritual needs of the patient and their family.
When a patient is admitted to hospice, they agree to forgo treatments aimed at curing their terminal diagnosis. For a secondary condition like bacterial pneumonia, the team evaluates whether treatment aligns with the goal of comfort. The focus shifts from eradicating the infection to ensuring the patient does not suffer from symptoms like fever, cough, or difficulty breathing. This commitment guides all medical decisions, ensuring the patient’s remaining time is spent with peace and dignity.
Comfort-Focused Management of Pneumonia Symptoms
The hospice approach to pneumonia management centers entirely on symptom relief. Respiratory distress is often managed using low-flow oxygen delivered via nasal cannula, primarily to ease the sensation of breathlessness rather than to correct blood oxygen levels. Opioids, including morphine or hydromorphone, are frequently administered to reduce the feeling of air hunger and alleviate pain. Benzodiazepines, like lorazepam, can also be used to reduce anxiety that often accompanies difficulty breathing.
Managing pain and fever is another priority, often achieved through oral or rectal administration of acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). Secretions, which can be distressing for the patient and family, are addressed through positioning the patient for drainage and using anticholinergic medications like scopolamine patches or glycopyrrolate. These medications reduce the production of saliva and bronchial secretions, making the patient less likely to experience a rattling sound in their chest or need suctioning.
The use of antibiotics is carefully considered and often referred to as “comfort antibiotics.” These are prescribed only if the hospice team, in consultation with the family, believes the medication will significantly improve the patient’s comfort without causing side effects that outweigh the benefits. This is a palliative decision; the goal is to relieve symptoms like high fever or purulent sputum, not to cure the infection or prolong life. If a short course of antibiotics can increase the patient’s well-being, it is administered within the home or hospice facility setting.
Patient and Family Role in Treatment Decisions
The process of deciding how to manage pneumonia begins long before the illness occurs, starting with the patient’s advance directives and initial conversations with the hospice team. These documents establish the patient’s wishes regarding aggressive interventions, such as hospitalization or mechanical ventilation. The hospice team ensures that the patient’s stated wishes and goals for quality of life are the guiding principles for all subsequent care decisions.
When pneumonia develops, the hospice team engages in shared decision-making with the patient and family, carefully outlining the potential benefits and burdens of any intervention. They explain that while a hospital stay with IV antibiotics might cure the pneumonia, it would likely involve uncomfortable procedures and remove the patient from familiar surroundings. The discussion centers on whether the proposed treatment aligns with the agreed-upon shift from life-extension to comfort maximization.
A patient always retains the autonomy to change their mind and pursue curative treatment for any condition, including pneumonia. If the patient or family wishes to pursue aggressive measures, they can formally revoke their hospice election by signing a written statement. Revocation allows the patient to resume coverage for curative treatments, such as hospitalization and intensive IV antibiotics, under their standard insurance. The patient can re-elect hospice care at a later time if they meet the eligibility criteria.