Which patient should the nurse refer for hospice care?

• A. A 70-year-old patient with lymphoma whose children are unable to discuss issues related to dying
• B. A 60-year-old patient with chronic severe pain as a result of spinal arthritis and vertebral collapse
• C. A 40-year-old patient with AIDS-related dementia who needs palliative care and pain management
• D. A 50-year-old patient with advanced liver failure whose family members can no longer provide care in the home.

Answer: (C)

Hospice care is for patients with a terminal illness and a prognosis of roughly six months or less if the disease runs its natural course, with a shift in focus from pursuing cure to comfort, symptom control, and support for both the patient and family. Palliative care, by contrast, can be provided at any stage of illness and may accompany curative treatment.

In AIDS-related dementia, the illness represents advanced disease with progressive cognitive decline and significant symptom burden. This situation commonly meets criteria for hospice because life expectancy is limited and the care needs are comprehensive—pain management, relief of distressing symptoms, and robust psychosocial/spiritual support for the patient and caregivers. The other scenarios involve conditions or circumstances that do not clearly indicate a terminal prognosis or the shift to comfort-focused care that hospice provides (for example, chronic nonterminal pain, or situations where prognosis is unclear or the primary need is ongoing home caregiving without a defined terminal trajectory).

Thus, the patient with AIDS-related dementia who needs palliative care and pain management is the best candidate for hospice referral.