No place like the hospital.

Area of Science:

• Palliative Care
• Medical Ethics
• Oncology

Background:

• Home hospice is the recognized standard for end-of-life care.
• Advance care planning and patient preferences are crucial in terminal illness.
• Hospital-based palliative care services have expanded to improve inpatient end-of-life experiences.

Observation:

• A patient with metastatic cancer and small bowel obstruction refused available home hospice and skilled nursing facility options.
• The patient insisted on remaining in an acute care hospital for terminal care.
• Ethical considerations involved patient autonomy, clinical team responsibilities, hospital policy, and insurance coverage.

Findings:

• Patient's insistence on hospital care highlights potential conflicts between patient wishes and optimal end-of-life care settings.
• Ethical dilemmas arise concerning patient autonomy versus the principles of palliative and hospice care.
• The availability and accessibility of insurance-covered hospice services did not alter the patient's preference for hospital-based care.

Implications:

• Increased demand for hospital-based terminal care may arise as palliative services improve inpatient dying experiences.
• Healthcare systems must navigate complex ethical issues when patient preferences diverge from established care standards.
• Further research is needed on patient decision-making regarding end-of-life care settings and the role of hospital palliative care.