When the hospice patient is manipulative

Oncology and hospice literature have addressed the problem of psychiatric complications, secondary to the stressors of diagnosis and treatment. This literature focuses particularly on depression and anxiety, which not only compound patients' suffering but also may interfere with optimal care. Little attention has been given, however, to the unique challenges of providing hospice care to patients with preexisting psychiatric conditions. As hospice care becomes increasingly mainstream in the health care system, we can expect to meet more patients with such conditions. In order to contribute to collegial dialogue that addresses this minority population in hospice services, a case study is presented in this article of the process of care for a hospice patient with a preexisting psychiatric condition. Interventions are suggested, using a theoretical matrix of hospice philosophy and principles of care for manipulative patients.