Should I suggest that Mom enter hospice care or continue to pretend she will "get better" even though she has terminal cancer? -

Should I suggest that Mom enter hospice care or continue to pretend she will "get better" even though she has terminal cancer?


My 80-year-old mother was diagnosed with incurable Stage 4 kidney cancer three years ago. She has never accepted the diagnosis and has tried all of the chemotherapy and radiation treatments available. She is no longer taking any cancer treatments and is on pain medication because the cancer has spread to her bones. Even though the doctors have tried to explain to her that there is nothing else they can do, she continues to believe that she is "going to get better." Both my father and my brother are encouraging her belief because they do not want her to give up hope. I think that it is time for hospice to be called to assist with end-of-life planning and to help my 81-year-old father who is her caregiver. I live out-of-state and will be visiting next week. I don't know whether I should "play along" and pretend that everything's going to be fine, or ask everyone to sit down and have an honest family discussion about what needs to be done. Any advice would be greatly appreciated.

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Thank you for the comments. I agree that it would not be a good idea to discuss this with my mother. She became very upset a few weeks ago when one of her doctors told her that the cancer had spread throughout her body and that she did not have long to live. She refused to accept his diagnosis and requested another round of radiation. After the radiation, she was barely able to eat or drink for several weeks. Nevertheless, she asked for, and received, more radiation this week. She told me yesterday that she only needs to take the pain medicine until she gets better. She believes that the radiation has "killed" the cancer and that she's in remission even though the doctors have told her that they are no longer treating the cancer in other parts of her body.

At this point, I think it's a good idea to talk to my brother and see whether he thinks we should arrange for hospice care. He went through this with his father-in-law several years ago when he was diagnosed with terminal cancer. I am very concerned about my father's health since he seems to be overwhelmed by the demands of caring for my mother 24/7. They have refused offers of help from family and friends because they want to maintain their independence. However, my mother tells me that there is no food in the house because my father keeps "forgetting" to buy things when he goes to the grocery store on his own. I am concerned that we need to intervene soon to make sure that both of them receive the care that they need.
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I'm a huge advocate of hospice and I work hospice cases myself occasionally.

It sounds as if your dad and brother know that your mom is terminal and that they're just keeping a stiff upper lip for your mom's sake so it's not like your entire family is in denial. Definitely broach the subject of hospice to your dad. His mind may snap shut because "hospice is for people who are dying" and the word "hospice" scares a lot of people but there will come a day when your mom's pain will need to be more closely monitored and hospice will do that. Get them on board before that day comes. It's much better to have hospice and not need it than to need hospice and not have it.
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I agree with getting hospice in, but maybe not calling it hospice to your mom? Just home healthcare or new Medicare services or something else. And these days, many people who do get hospice do get better and go off of it.

I had a friend with kidney cancer who passed away but when we took him to Johns Hopkins for a second opinion, the specialist said it was a tricky cancer, as it can sort of start and stop. So I'd hold out hope but also work with your dad and brother to make sure all of the bases are covered as far as end of life care.

Does your mom want to be resuscitated if her heart stops? If not, get a Do Not Resuscitate order (DNR) in place. Would your mom want a feeding tube? Those are the really tough questions your family needs to decide on before you hit that point with no clear direction. Hugs to you, this isn't easy whatever you do.
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It's a tough call but I'd do as has been suggested and perhaps a private chat with your father and brother. My mother, 88, in a nursing home, is convinced she's only got worse in the 18 months she's been there (nothing at all to do with parkinsons, strokes, dementia and a broken hip) and if only she can get out of there she'll get so much better and be able to walk and talk without slurring. Of course it's all my fault she has health issues and needs care 24/7 {rolling eyes}. She obsesses about getting out of "prison" and getting well again . If I go along with her she obsesses and fantasizes even more. If I try to reason with her she goes off the walls. Can't win either way, just try to handle the constant tongue lashings :(

It sounds like your mother is of sound mind and, as been said, she my be taking this stand to protect the rest of the family from grief. In the end, there must always be hope.
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There's no harm in your mother continuing to believe she's going to "get better." You didn't say whether she expects a full recovery, or if she thinks her cancer is going to go into remission, but it really doesn't matter; she's been given a diagnosis and she refuses to accept it. That was her choice, and I applaud her optimism. If the cancer hasn't metastasized to her brain, and her pain meds aren't clouding her judgement, then she's made the decision to hope, despite the odds being against her. Arguing with her, and trying to make her "face reality" would be a bad idea, IMO. It would only make her upset, and why do that?

It's also possible that she knows the truth, and her assertion that she'll get better is for the sake of your father, your brother and you, to try and lift your spirits. Who knows what she really thinks? People can be a mystery, even to those closest to them.

Getting hospice on board wouldn't necessarily crush your mom's belief that she's going to get better, if that's what she thinks. They could help with her hands-on care and discuss end-of-life planning in private with your father. It's not as if they march in and announce to the patient that they're there because he or she is going to die soon.

Why not talk things over privately with your father and brother?
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