Takeaway
Hospice conversations should happen before a crisis, not during one. When framed around a patient's values and goals, hospice becomes less about giving up and more about how they want to spend the time they have left.
Lifelong learning in clinical excellence | October 15, 2026 | 1 min read
By Ivy Akid, MD, MPH, Johns Hopkins Medicine
Patient scenario
A 67-year-old man with advanced colorectal cancer was informed by their oncologist that further chemotherapy wouldn’t be safe or beneficial. You’re meeting with the patient to discuss transition of care and want to bring up hospice as an option—but bringing up hospice can feel challenging.
Talking about hospice with patients
Many patients and families become scared when they hear the word hospice because they equate hospice with death, giving up, or stopping care. However, hospice is often more care with many wrap-around services, as well as a resource that people are entitled to under their insurance benefits. Hospice is best discussed before a crisis, when patients and families have the emotional capacity and time to understand their options and make thoughtful decisions.
Hospice should be considered when a serious illness is progressing and the burdens of the illness or treatment are greater than any meaningful benefit those treatments provide. The conversational tone set by clinicians should be serious, honest, and gentle. It should also be treated as a standard part of advance care planning.
UPLIFT
The UPLIFT framework offers an approach to this discussion:
Understanding – assess the patient’s understanding of the illness
Permission – ask permission to have a conversation about hospice
Look ahead – explore hopes, fears, concerns, and meaning making at the end of life with the patient
Inquire – inquire about previous experiences with hospice to reveal and discuss biases
Framing – frame hospice around the patient’s values and alignment with their goals
Tailor – offer tailored recommendations on why hospice and why now based on the patient’s values and goals
Hospice discussions are ultimately about how people want to live with the time they have left. These conversations are about preserving dignity, creating meaning, and making a hard experience less hard for patients and their loved ones. We can help reframe hope to focus on comfort, peace, living as fully possible, and being in their preferred setting at the end of life.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.