How to Incorporate Functional Medicine Into Hospice Patient Care

Hospice is comprehensive care for people who are no longer seeking curative care for their medical problems and who, if their illness runs its natural course, have a prognosis of six months or less to live. Hospice services can be provided in most settings, including hospitals, nursing homes, and the patient’s home. Hospice doesn’t require the patient to stop all treatment; palliative therapies are still allowed, as is treatment for other medical conditions the patient may have.[12] 

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Introduction to Functional Medicine in Patient Care

Functional medicine is a whole-person, patient-centered approach to patient care. Functional medicine approaches patients from a systems biology approach and focuses on finding and treating the root cause of a disease.[9] Many factors affect how a disease develops and affects an individual patient. These may include:

• Genetic
• Environmental
• Lifestyle
• Spiritual
• Social 

Addressing all of the systems that affect the individual patient can provide more benefit to the patient than just addressing the symptoms of the disease.[9]

Importance of Integrating Functional Medicine in Hospice Settings

Functional medicine can complement conventional medicine greatly, especially in the hospice setting. Hospice strives to ease the end-of-life transition for the patient and the family. This can mean managing symptoms but also addressing the patient's other needs, including emotional and spiritual support. 

Functional medicine’s person-centered approach, which incorporates how all aspects of the patient's life affect their health, complements this goal very well. Functional medicine is another tool for addressing symptom management, patient comfort, and emotional support for patients and those close to them.

The Core Principles of Functional Medicine

Functional medicine focuses on identifying and addressing the root causes of disease through a patient-centered approach.

Understanding the Whole-Person Approach

At the heart of functional medicine is its whole-person approach. Functional medicine develops personalized care plans that address the interconnections of body systems. Functional medicine considers in-depth and specialty lab testing to address health concerns on a deeper level and provide a more personalized care plan.[3]

Differences Between Functional Medicine and Conventional Hospice Care

The conventional approach to hospice care addresses the emotional and spiritual needs of the patient and their family. Still, much of the focus for this type of care is on managing the symptoms of the illness for the comfort of the patient. Functional medicine explores these needs in a more in-depth manner. A functional medicine medical history includes comprehensive information about the patient, including[13]:

• Medical history
• Family history
• Lifestyle history
• Exercise
• Past trauma experience
• Diet
• Symptoms

This history, combined with the more in-depth labs that functional medicine providers frequently use, can help the provider develop a more personalized patient care plan that goes beyond symptom management and addresses the patient as a whole, interconnected being. This can create a synergistic relationship with the conventional hospice team and improve patient experience.

Assessing Hospice Patient Needs Using Functional Medicine

Integrating functional medicine principles into hospice care enhances the understanding of patient needs by addressing the underlying factors that affect their overall well-being.

Holistic Patient Assessments in Hospice Care

Every patient has care needs that are influenced by multiple life factors. There are needs related to the specific medical condition, those influenced by their spiritual and psychological states, and needs influenced by their social support. In the hospice setting, these needs may vary as the care goals differ. A holistic approach to assessing the needs of patients at the end of life includes evaluating their physical, emotional, spiritual, and social needs.[10]  

Identifying Root Causes in Symptom Management

One of the principles of functional medicine is addressing the root cause of illness rather than just the symptoms. Root cause medicine approaches symptoms and disease from a whole-person perspective and understands that the genetic makeup, diet, stress levels, microbiome, emotional state, and other factors all play a role in illness and symptoms.[11] Considering these factors allows the functional medicine provider to offer more tailored approaches to pain, fatigue, and digestive concerns.

Key Functional Medicine Strategies in Hospice Patient Care

Implementing key functional medicine strategies in hospice care can enhance patient comfort and overall well-being.

Integrating Nutrition and Hydration Support

In hospice care, the patient's comfort is one of the most important care goals. Hydration is essential for the human body, as it is mainly made of water. Water facilitates the transport of nutrition through the body.[5] It also helps rid the body of waste and keeps the mucous membranes moist. 

From the functional medicine perspective, food is a form of medicine that can help improve overall health and comfort. The functional medicine approach to nutrition and hydration focuses on optimizing comfort, including sips of fluids and small, frequent, nutrient-dense meals.[8] The patient’s appetite will decline naturally during the end-of-life decline.

Addressing Symptom Management Through Functional Medicine

Functional medicine providers can help with symptom management for hospice patients. Vitamin D, Vitamin C, and omega-3 fatty acids are all supplements that may offer pain control and decrease inflammation.[3,6,7] Other therapies, such as complementary and alternative medicine, yoga, meditation, breathing techniques, or acupuncture, may also offer symptom relief.[4,8,15]

Enhancing Emotional and Psychological Support

Emotional and psychological support for patients and their families is vitally important for end-of-life patients. Addressing these needs is important when considering the whole-person approach to patient care. Integrative therapies such as mindfulness meditation, exercise therapy, and counseling may help address these needs.

Functional Medicine and Palliative Care

Palliative care encompasses more than just hospice care. Functional medicine can play an important role in addressing these patients' quality of life and comfort. Functional medicine can combine nonpharmacologic therapies along with the treatments recommended by the conventional medicine team. Supplements, massage therapy, acupuncture, meditation, and other techniques may be recommended to help with symptom management and patient comfort.[8]

Collaborating with Healthcare Teams in Hospice Care

Collaborative efforts between functional medicine practitioners and hospice care teams are essential for delivering comprehensive, patient-centered care at the end of life.

Bridging Functional Medicine and Traditional Hospice Teams

Integrating functional and traditional medicine teams in hospice care is crucial to patient care. This is true for collaborative care in any patient. Collaboration between the functional and traditional medicine teams can help avoid medications or treatments that interact. Collaboration allows the teams to develop a more comprehensive and effective plan for immediate and longer-term support.[14]

Creating an Interdisciplinary Care Plan

Communication between the traditional and functional medicine care teams and the patient and their family is important to developing a comprehensive and cohesive care team. Sharing care notes and details from visits for each team is one way to facilitate this communication. Fostering an environment that allows for mutual education between the traditional and functional medicine teams can help bridge the gap and promote better patient care.[14]

Potential Challenges and Solutions

While integrating functional medicine into hospice care holds great promise, it also presents challenges that require thoughtful solutions to ensure seamless and effective patient support.

Navigating the Integration of Functional Medicine in Hospice Settings

Integrating the functional medicine team into the hospice setting isn’t without challenges. Traditional medicine care teams may not understand the role that functional medicine providers may play in patient care. There may be resistance to collaboration and integration into patient care. 

This can be relayed to the patient either consciously or unconsciously and undermine the role of the functional medicine provider. Fostering a mutual understanding of the philosophies and approaches of both teams can aid with the integration and collaborative approach between the teams.

Addressing Skepticism in Hospice Patient Care

Addressing skepticism toward functional medicine can be difficult. Skepticism may come from the patient, their family, or other healthcare providers. Continuing education is a common option for addressing skepticism among healthcare providers, but addressing concerns may also involve demonstrating the evidence that supports the use of functional medicine. Studies support the use of functional medicine in improving patient care.[1,2]

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Key Takeaways

Functional medicine may significantly improve patient outcomes when used in collaboration with traditional medicine teams in hospice care. There are many opportunities for healthcare professionals to learn more about how functional medicine can augment patient care and improve patient satisfaction and outcomes.

• Functional medicine can be a great complement to the conventional approach to hospice care.
• Combining functional medicine with conventional hospice care can lead to better patient satisfaction.
• Small, frequent, nutrient-dense meals and hydration may help with comfort.
• Supplements and exercise may help with symptom control.
• Collaboration between functional medicine providers and traditional hospice care teams requires mutual respect and strong communication.
• Challenges for incorporating care may also include addressing skepticism toward the role of functional medicine.