This is the second installment in a six-part series by hospice and palliative care physician Dr. Tracy Romanello, DO, FACOFP, FAAHPM, HMDC. This article explores misconceptions that can delay valuable care for patients and families facing serious and terminal illness and examines why supportive care still arrives far later than it should.
A simple phrase in medicine has created a surprising amount of confusion: “I think it may be time for palliative care.” Those words can stop a conversation in its tracks, triggering apprehension and uncertainty about what comes next.
I have seen that reaction countless times because palliative care remains one of the most misunderstood specialties in medicine. Patients commonly assume it means death is imminent, treatment is ending, or hope has somehow been lost. Many people fear palliative care not because of what it is, but because of what they imagine it to be.
A patient once leaned intently towards me with eyes wide and asked, “Wait... are you sending me to the place where people go to die?” Before I could answer, his wife quickly replied, “No, Frank. We already live in Florida.”
Humor aside, misconceptions about palliative care and hospice remain remarkably common. All too often, these misunderstandings delay services that could reduce suffering and provide meaningful guidance during some of life's most difficult moments.
For osteopathic family physicians, this conversation feels especially relevant because our philosophy is rooted in whole-person care. Long before "holistic care" became a healthcare buzzword, we recognized that curing and healing are not always the same thing.
Among the most persistent misconceptions is that palliative care begins only when curative or life-prolonging treatment ends. Many patients receiving palliative care are simultaneously pursuing chemotherapy, radiation, dialysis, transfusions, immunotherapy and other advanced therapies. Palliative care focuses on symptom management, communication, decision-making, advance care planning and helping people live as well as possible with serious illness.
Palliative care does not mean stopping care. Rather, it means expanding care. It walks alongside patients and loved ones facing serious illness and can be introduced at any stage of disease, even at the time of diagnosis.
Unfortunately, palliative care is frequently introduced far too late. By the time a referral occurs — someones after repeated hospitalizations, uncontrolled symptoms, caregiver exhaustion, and mounting distress — patients and families may be hearing about palliative care for the first time while simultaneously facing discussions about hospice.
It is easy to understand how the two become blurred together. Hospice is a form of palliative care for patients nearing the end of life. Simply put: all hospice is palliative care, but not all palliative care is hospice.
When palliative care is introduced only near the end of a long illness, families naturally assume it is synonymous with hospice. It is during these moments that I often hear the same sentiment:“I wish we had known about this sooner.”
The good news is that family physicians already practice primary palliative care every day — managing symptoms, supporting caregivers, discussing goals, addressing anxiety, and helping patients navigate uncertainty. These conversations have always been part of comprehensive, relationship-centered care. Osteopathic family physicians are uniquely positioned for primary palliative care because we know our patients across decades, understand the context of their families and communities, and are often trusted to guide conversations that extend far beyond diagnoses and treatments.
As illness advances, another misconception commonly emerges: the belief that hospice means giving up. Hospice is not abandonment. Hospice is not “doing nothing.” Rather, it is an intentional shift towards maximizing comfort and aligning care with what matters most to the patient when curative therapies are no longer effective, no longer desired, or no longer aligned with individual goals.
In my role as a hospice physician, one of the most difficult realities I witness is how late many patients arrive to hospice care. Some are admitted to hospice with just hours- or even minutes- before death. While hospice teams remain honored to care for every patient entrusted to them, late referrals can deprive patients, loved ones, and hospice staff of something precious: TIME- time for adequate symptom relief, emotional and spiritual support, and the opportunity to thoughtfully prepare for goodbye.
There is a poignant irony in knowing that bereaved family members may later receive a survey about whether hospice effectively managed symptoms, communicated clearly, provided needed emotional and spiritual care, or met their overall needs. I wonder whether those survey questions quietly echo a different and more difficult one altogether: What might have been possible if hospice had been introduced sooner? For some families, that question lingers long after the survey is completed, leaving them to wonder whether greater comfort, focused support, more peace, or a gentler goodbye might have been possible.
Misconceptions about hospice do not end with timing alone. Families may fear that morphine is used to hasten death when in reality it is carefully prescribed to relieve pain and shortness of breath. Others worry hospice is "starving" patients when decreased appetite is a natural consequence of advanced illness, and comfort-focused eating is encouraged. There is also confusion about what hospice provides. Hospice includes medical care, nursing, medications, equipment, social work, chaplaincy, bereavement services, interdisciplinary guidance, and more. At the same time, hospice is not intended to replace around-the-clock caregiving, and families generally continue to provide much of the day-to-day hands-on care with support from the hospice team.
One patient once told me, “I thought hospice was where people went to take their last breath. Turns out, you helped me finally sleep through the night for the first time in months.” That simple praise lingers with me because it captures the gap between what people fear hospice will be and what it so often proves to be.
As osteopathic family physicians, we can help to close that gap. Our long-standing relationships allow us to guide patients through changing health and priorities with honesty and compassion. Whether through primary palliative care, palliative specialty consultation, or hospice services, our responsibility remains the same: to relieve suffering, honor individual values, and care for the whole person.
If there is one misconception worth retiring, it may be this: palliative care and hospice are not about giving up. They are about showing up- earlier, more intentionally, and with unwavering commitment to every person entrusted to our care.
About Dr. Romanello
Dr. Tracy Romanello is a physician executive and recognized leader in hospice and palliative medicine, with more than a decade of experience advancing care across acute and post-acute settings in South Florida. She currently serves as a Medical Director for Catholic Hospice and Palliative Care Services and the Vice President of the Medical Staff at Catholic Health Services. Board-certified in Family Practice and Osteopathic Manipulative Treatment, and Hospice and Palliative Medicine, Dr. Romanello is a Fellow of the American College of Osteopathic Family Physicians and the American Academy of Hospice and Palliative Medicine. She is the founding visionary of an integrated palliative care program that includes inpatient consultation, community-based services, and a fully accredited fellowship. Dr. Romanello serves on the Boards of the Broward County Osteopathic Medical Association and the Florida Hospice and Palliative Care Association. A dedicated educator, speaker, and nonprofit leader, she is committed to mentorship, innovation, and compassionate, high-value care.
Continue the conversation by contacting Dr. Romanello.
