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Examining hospice enrollment through a novel lens: Decision time

Published online by Cambridge University Press:  13 July 2016

Cara L. Wallace
Cara L. Wallace*
Affiliation:
Saint Louis University, School of Social Work, St. Louis, Missouri
*
Address correspondence and reprint requests to: Cara L. Wallace, School of Social Work, Saint Louis University, 3550 Lindell Boulevard, Tegeler Hall, Room 302, St. Louis, Missouri 63103. E-Mail: [email protected]; [email protected].
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Abstract

Objective:

No prior studies on hospice utilization have captured information about the amount of time between when one first learns of hospice as a potential option for care and when he/she actually enrolls. Little is in fact known about this decision-making process. The present study examines hospice enrollment by exploring relationships between hospice decision time and known barriers to care.

Method:

This was an exploratory cross-sectional study. Pearson's r was employed to identify bivariate relationships between barriers to care and decision time for hospice care. Independent-sample t tests and ANOVA were utilized to consider differences in decision time across key variables.

Results:

Some 90 hospice patients, or their primary decision maker, participated in the study from a not-for-profit hospice located in the southern United States. Decision time was correlated with referral source, use of disease-directed treatment, functional status (on the Palliative Performance Scale [PPS]), age, diagnosis, income, race, and spirituality—suggesting that decision time is a pertinent variable when examining hospice utilization. Differences in decision time were found across diagnosis, race, income, and referral source.

Significance of results:

This study provides implications for policy and practice, particularly for clinicians faced with initial conversations about hospice care. Differences in decision time highlight ongoing needs related to overcoming healthcare disparities, the important role of including families in initial conversations, and the potential need for varied approaches to talking about hospice care based upon diagnosis. Results also highlight the need for policies supportive of concurrent care, where hospice can be accessed alongside curative care.

Keywords

End of lifeDecision makingHospice utilization
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 2 , April 2017 , pp. 168 - 175
Copyright
Copyright © Cambridge University Press 2016 

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References

REFERENCES

Anderson, F., Downing, G.M., Hill, J., et al. (1996). Palliative performance scale (PPS): A new tool. Journal of Palliative Care, 12(1), 5–11.Google Scholar
Bullock, K. (2011). The influence of culture on end-of-life decision making. Journal of Social Work in End-of-Life & Palliative Care, 7(1), 83–98.Google Scholar
Chen, H., Haley, W.E., Robinson, B.E., et al. (2003). Decisions for hospice care in patients with advanced cancer. Journal of the American Geriatrics Society, 51(6), 789–797.Google Scholar
Gozalo, P.L., Miller, S.C., Intrator, O., et al. (2008). Hospice effect on government expenditures among nursing home residents. Health Services Research, 43(1), 134–153.Google Scholar
Head, B., Ritchie, C.S. & Smoot, T.M. (2005). Prognostication in hospice care: Can the palliative performance scale help? Journal of Palliative Medicine, 8(3), 492–502.Google Scholar
Higgins, P.C. & Prigerson, H.G. (2013). Caregiver Evaluation of the Quality of End-of-Life Care (CEQuEL) Scale: The caregiver's perception of patient care near death. PLoS One, 8(6), e66066.Google Scholar
Kelley, A. S., Deb, P., Du, Q., et al. (2013). Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay. Health Affairs, 32(3), 552–561.Google Scholar
Meeker, M.A. & Jezewski, M.A. (2005). Family decision making at end of life. Palliative & Supportive Care, 3(2), 131–142.Google Scholar
National Alliance for Caregiving (2009). Caregiving in the U.S. Available from http://www.caregiving.org/caregiving2015/.Google Scholar
National Hospice and Palliative Care Organization (2015). Facts and figures: Hospice care in America. Available from http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf.Google Scholar
Office of Disease Prevention and Health Promotion (2014). Healthy people 2020: Access to health services. Available from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services.Google Scholar
Pecchioni, L.L., Thompson, T.L. & Anderson, D.J. (2006). Interrelations between family communication and health communication. In The Family Communication Sourcebook. Turner, L.H. & West, R. (eds.), pp. 447–468. Thousand Oaks, CA: Sage.Google Scholar
Quill, T.E. (2007). Is length of stay on hospice a critical quality of care indicator? Journal of Palliative Medicine, 10(2), 290–292.Google Scholar
Rickerson, E., Harrold, J., Kapo, J., et al. (2005). Timing of hospice referral and families' perceptions of services: Are earlier hospice referrals better? Journal of the American Geriatrics Society, 53(5), 819–823.Google Scholar
Schmid, B., Allen, R.S., Haley, P.P., et al. (2010). Family matters: Dyadic agreement in end-of-life medical decision making. The Gerontologist, 50(2), 226–237.Google Scholar
Shrank, W.H., Kutner, J.S., Richardson, R., et al. (2005). Focus group findings about the influence of culture on communication preferences in end-of-life care. Journal of General Internal Medicine, 20, 703–709.Google Scholar
Smith, A.K., Sudore, R.L. & Perez-Stable, E.J. (2009). Palliative care for Latino patients and their families: Whenever we prayed, she wept. The Journal of the American Medical Association, 301(10), 1047–1057.Google Scholar
Teno, J.M., Shu, J.E., Casarett, D., et al. (2007). Timing of referral to hospice and quality of care: Length of stay and bereaved family members' perceptions of the timing of hospice referral. Journal of Pain and Symptom Management, 34(2), 120–125.CrossRefGoogle ScholarPubMed
Vig, E.K., Starks, H., Taylor, J.S., et al. (2010). Why don't patients enroll in hospice? Can we do anything about it? Journal of General Internal Medicine , 25(10), 1009–1019.Google Scholar
Waldrop, D.P. & Meeker, M.A. (2012). Hospice decision making: Diagnosis makes a difference. The Gerontologist, 52(5), 686–697.Google Scholar
Wallace, C.L. (2015). Hospice eligibility and election: Does policy prepare us to meet the need? Journal of Aging & Social Policy, 27(4), 364–380.CrossRefGoogle ScholarPubMed
Wallace, C.L. & Adorno, G. (2014). Transitioning to hospice: The role of family communication. Paper presented at the Annual Conference of the Society for Social Work and Research, San Antonio, Texas.Google Scholar
Wilner, L.S. & Arnold, R.M. (2006). The Palliative Performance Scale #125. Journal of Palliative Medicine, 9(6), 994.CrossRefGoogle Scholar
Xu, J.Q., Murphy, S.L., Kochanek, K.D., et al. (2016). National vital statistics reports, Vol. 64, no. 2. Available from http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf.Google Scholar
Zhang, B., Wright, A.A., Huskamp, H.A., et al. (2009). Health care costs in the last week of life: Associations with end-of-life conversations. Archives of Internal Medicine, 169(5), 480–488.Google Scholar