The hospice referral.

Commentary Hospice is a program of care and support for persons facing life-limiting illnesses. Hospice care involves a team-oriented approach to medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes.1 Most caregivers and families of patients who have received hospice care report that they would have welcomed more information about hospice from their primary care physician at the time the diagnosis was labeled terminal.2 One significant barrier to hospice referral is physician discomfort in communicating a terminal diagnosis and prognosis.2 Although discussing hospice can be more complex than delivering bad news, the tools developed for communicating serious news can be adapted to aid clinicians in this process. One such tool is the SPIKES protocol for delivering bad news (Table 1).3 The protocol is comprised of six communication steps summarized by the mnemonic SPIKES: set up, perception, invitation, knowledge, emotion, and summary.