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The Importance of a Suicide Risk Assessment in Hospice Care


The rate of suicide in the United States’ terminally ill population is unknown. However, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reports suicide in the top reported sentinel events across healthcare organizations many years running.

Every hospice staff member should be educated on what to listen for from their patients and how to respond to those who are exhibiting signs of emotional distress and having suicidal thoughts. It is the organization’s responsibility to instill hope and positivity in these patients and their families during the hospice experience.

Who Is at High Risk for Suicide?

Advancing age, psychiatric illness, an acquired immunodeficiency syndrome (AIDS) diagnosis, a family history of suicide and uncontrolled pain are all associated with an increased risk of suicide.

Furthermore, cancer patients experience nearly twice the incidence of suicide compared to the general population. Lung, prostate, pancreatic, head and neck cancers have the highest suicide rates among all cancer types. Up to 8.5% of terminally ill cancer patients express an ongoing desire for an early death, which may not result in suicide attempts, but is worthy of deeper observation by the hospice interdisciplinary group (IDG).

Not All Changed Behavior Is Cause for Concern

It is important to recognize that not all signs of anxiety or depression in hospice patients mean suicidality but could be normal responses to life changes. With more than 27 years as a hospice social worker, Sue Peterson recommends IDG members who help patients and families focus on hospice as a continuation of living rather than a focus on dying can alleviate distress experienced.

However, when there are verbalizations about suicidal thoughts, or a history of suicide for the patient or their family, additional assessment is needed.

For the in-depth assessment of a potential suicide risk, consider using a hospice social worker or chaplain. These staff possess more education and experience in assessing the risk of suicidality and how to best identify the root causes compared to other IDG members.

Best Practices for a Hospice Suicide Risk Assessment

There is no consensus on how often a suicide risk assessment should be done in the hospice setting.

While it is a myth that bringing up suicide will cause a person to become suicidal, there is also no evidence of benefit to screening everyone for suicide risks in all healthcare settings. It is considered best practice to develop protocols for your organization on who and when suicide risk assessments should be completed.

Axxess Hospice uses the Columbia Protocol — also known as Columbia-Suicide Severity Rating Scale (C-SSRS) – to assess suicide risk. This tool has been validated and shown to be a reliable indicator of assessing the likelihood of a suicide attempt. It also allows for clinical judgment to determine the best interventions for the specific patient, with guidance for immediate interventions as indicated.

The C-SSRS tool has been approved by JCAHO and other health organizations to assist with promoting patient safety.

Patient Suicide Affects the Hospice Organization

Research has shown that completed suicide has a strong impact in many ways on members of the IDG.

Even though hospice patient deaths are expected, the unexpected death by suicide requires increased support of the clinical team. The responses of the IDG could have lasting impacts on clinicians’ behavior, including loss of confidence in their judgment, preventive overuse of psychiatric hospitals and hypervigilance with respect to suicide.

When assessing patients for suicide risk, the use of validated assessments will ensure that your clinicians have access to proven tools to complete their responsibilities, protecting both the patient and the clinician.

Axxess Hospice, a cloud-based hospice software, provides the necessary tools for accurate identification of patients at high risk for suicide.

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