The importance of the physician’s relationship with a terminally ill patient and his or her family throughout the course of illness cannot be overemphasized. In a focus group discussion conducted through the Allina Foundation’s Project DECIDE, one patient commented, “You are so tied to physicians, you are relying on them for the lifeline. If they suggest an option, you think, OK, I guess I better look at this.” Another reiterated the trust relationship: “I just went along with what the doctor said…I thought he knew what to do and would take care of it” (Allina Foundation, 1994 ).
The physician is a key member of the hospice team. From initiating the discussion about hospice to signing the death certificate, the physician’s involvement is crucial to the patient, family and other members of the hospice team. Yet many physicians, especially those who refer to hospice only occasionally, may not be aware of the full range of services offered by hospice or the tremendous growth experience at the end of life that can occur within patients and families.
In addition to the physician, the hospice team includes nurses, home health aides and homemakers, social workers, chaplains, and volunteers. Under the physician’s direction, the hospice team specializes in pain and symptom management, and provides support for the family as well as the patient.