• The hospice model of care is based upon the concept of "total pain," which acknowledges that patients with serious and life-limiting illness suffer because of physical, emotional, social and spiritual sources of pain and suffering. 

  • Pain and suffering are related, but not necessarily the same. Pain, whether physical or emotional, has a physiologic basis. Suffering, on the other hand, arises when we apply meaning to or tell ourselves stories about the pain we are experiencing. 

  • Pain can often be alleviated or improved with medication, whereas suffering often is resistant to medication. Failing to recognize the difference can lead to over-medication and over-sedation of patients who have serious and life-limiting illness. 

  • Seriously ill patients and their families often resist the recommendation for a hospice referral due to concern about over-sedation and over-medication. Understanding the role of the hospice team in addressing total pain can enable to referring physician to alleviate these concerns. 

  • Suffering can be successfully evaluated and treated by using a spiritual pain model that addresses the following four aspects: forgiveness, meaning, relatedness, and hope. (See "Supplementary Online Resources" below to access a spiritual health evaluation clinical tool offered by the Sacred Art of Living Center.)  

  • Pain and suffering, particularly in the setting of terminal illness, often involves and affects the caregivers in addition to the patient. The hospice team can be a valuable resource in terms of time and expertise in helping the referring physician address and manage the complex impact of pain and suffering on family relationships.  

  • The hospice transdisciplinary team is comprised of compassionately skilled professionals from many disciplines who work as a cohesive and integrated unit. This allows the patient and family to receive focused care that addresses the complexity of terminal illness.  

  • The appropriate management of suffering, especially spiritual pain, requires time, and is best delivered by hospice involvement early in the course of a terminal illness.  

  • Appropriately timed referrals that allow sufficient time for hospice to do this important work are fundamental to maximizing quality of life and achieving peace for both the patient and caregiver.