Appearance
Hospice/Palliative Care Genogram Template
A genogram template for end-of-life care settings; mapping family structure, caregiving roles, and relational dynamics for palliative care teams and bereavement planning.
Hospice/Palliative Care Genogram Template
What This Template Shows
Four generations mapped around a terminally ill patient as the primary person.
The patient carries a terminal illness marker; a heart disease. His spouse carries an anxiety marker. Both of his parents are deceased. His elder son lives nearby and is the primary caregiver; they have a close relationship. His younger son is geographically distant and has a distant relationship with the patient. The two sons are in conflict with each other.
The end-of-life tension sits visibly in the diagram: one son present and engaged, the other absent and disengaged, the conflict between them landing beside a dying patient and an anxious spouse who are left to manage it.
This is the family picture a palliative care team needs before a family meeting; who is in the room, who is not, and where the disagreements are likely to surface.
The symbol legend is displayed below the diagram. For full definitions and clinical usage, see Genogram Symbols Explained.
When to Use This Template
- Palliative care intake and family assessment: map the patient's family structure, caregiving network, and the main relational dynamics at the start of palliative care to inform the care team's approach.
- Hospice team family meeting preparation: use the genogram as a visual tool before or during family meetings to make roles, responsibilities, and tensions transparent.
- Bereavement planning and anticipatory grief mapping: identify family members who may need bereavement support, and where grief responses are likely to be complicated by existing conflict or distance.
- Palliative care nursing and social work coursework: meets standard documentation requirements for palliative care and hospice social work tracks within BSW and MSW programs.
How to Use This Template
1. Download as-is
Click the PDF or PNG button under the embed to download immediately. Use as a clinical reference, care team handout, or teaching example.
2. Customize before downloading
Click "Use this genogram" to open the template in EasyGenogram. Replace the generic labels with real or fictional names, adjust the family structure, and update the health markers and relationship lines to reflect the actual patient's family situation.
Export as PDF or PNG when done, or share via link with a care team, supervisor, or colleague.
Hospice/Palliative Care Genogram Template
Explore this genogram and adapt it to your needs.
FAQ
What is a hospice genogram template?
A hospice genogram template is a family diagram used in end-of-life care settings to map the patient's family structure, caregiving roles, and relational dynamics. It gives the palliative care team a visual record of who is involved in the patient's care, where the key relationships sit, and where family tensions may affect decision-making, care coordination, and bereavement.
How is a palliative care genogram different from a standard family genogram?
The structure and notation are the same, but the clinical focus shifts at the end of life. A palliative care genogram prioritizes who is present versus absent, who holds healthcare decision-making authority, where family conflict may complicate treatment goals, and which family members are likely to need bereavement support. Health markers focus on the patient's terminal diagnosis and the hereditary conditions relevant to surviving family members rather than the full multigenerational health picture.
What does a hospice genogram include?
A hospice genogram covers the patient's immediate family and at least one generation above and below. It documents the patient's health status and terminal diagnosis, main caregiving relationships, family members who are geographically or emotionally absent, conflict lines between family members involved in care decisions, and the emotional relationships that will shape the bereavement process after the patient's death.
Is this template free?
Yes. Open and customize it in EasyGenogram at no cost. Export requires a subscription for most users; students with a valid school email can export free.
Can I use this for a palliative care or hospice social work assignment?
Yes. The template follows McGoldrick-Gerson-Petry standard notation and includes the markers and relationship lines relevant to palliative care and hospice social work documentation. Open it in EasyGenogram, adjust the family structure to match your assignment or case, and export as PDF for submission.