In the hospice hip fracture scenario, what is the most appropriate approach when the patient directs you not to go to the hospital?

• A. leave the scene immediately.
• B. encourage hospital.
• C. apply a traction splint.
• D. immobilize and transport.

Answer: (B)

In hospice care, care decisions are guided by the patient’s goals and comfort. A hip fracture is very painful and can lead to complications; even when a patient says they don’t want to go to the hospital, the best approach is to engage the patient in a thoughtful discussion and encourage hospital admission if that aligns with their goals of care. This allows for proper pain management, evaluation for other issues, and coordination with the hospice team to ensure the plan remains consistent with the patient’s wishes. It keeps the door open for reassessment with professional guidance and prevents abandonment of care. The other options would either neglect the need for evaluation and pain control or override the patient’s expressed preferences without providing the opportunity to revisit the decision with the support of the hospice team.