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Tate CE, Venechuk G, Brereton EJ, Ingle P, Allen LA, Morris MA, Matlock DD. "It's Like a Death Sentence but It Really Isn't" What Patients and Families Want to Know About Hospice Care When Making End-of-Life Decisions. Am J Hosp Palliat Care 2019; 37:721-727. [PMID: 31888342 DOI: 10.1177/1049909119897259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hospice is underutilized, due to both lack of initiation from patients and late referral from clinicians. Prior research has suggested the reasons for underuse are multifactorial, including clinician and patient lack of understanding, misperceptions about the nature of hospice care, and poor communication during end-of-life discussions about hospice care. Little is known about the decisional needs of patients and families engaging in hospice decision-making. OBJECTIVES To understand the decisional needs of patients and families making decisions about hospice care. METHODS We conducted focus groups with family caregivers and hospice providers and one-on-one interviews with patients considering or enrolled in hospice care. We identified participants through purposeful and snowball sampling methods. All interviews were transcribed verbatim and analyzed using a grounded theory approach. RESULTS Four patients, 32 family caregivers, and 27 hospice providers participated in the study. Four main themes around decisional needs emerged from the interviews and focus groups: (1) What is hospice care?; (2) Why might hospice care be helpful?; (3) Where is hospice care provided?; and (4) How is hospice care paid for? DISCUSSION Hospice may not be the right treatment choice for all with terminal illness. Our study highlights where patients' and families' understanding could be enhanced to assure that they have the opportunity to benefit from hospice, if they so desire.
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Affiliation(s)
- Channing E Tate
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Grace Venechuk
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Elinor J Brereton
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Pilar Ingle
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Larry A Allen
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megan A Morris
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel D Matlock
- ACCORDS, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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Sela-Katz P, Werner P. The Alzheimer's Disease Home Hospice Knowledge Scale: development, validity and reliability. Int J Palliat Nurs 2019; 24:108-114. [PMID: 29608380 DOI: 10.12968/ijpn.2018.24.3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several instruments are available to assess knowledge about hospice care, but none specifically address knowledge about home hospice for persons with Alzheimer's disease (AD). AIM To develop and validate the Alzheimer's Disease Home Hospice Knowledge Scale (AD-HHK-S). METHODS A total of 107 Israeli family caregivers of persons with dementia (mean age=71.2; 73% female) participated in the study. RESULTS The AD-HHK-S included 28 true/false items assessing 3 areas of knowledge: knowledge about hospice, knowledge about home hospice, and knowledge about home hospice for AD. Good internal reliability was found, with Cronbach alpha ranging from 0.72 to 0.85. Good face, construct and predictive validity were found. CONCLUSIONS The AD-HHK-S proved to be a valid and reliable tool to assess knowledge about hospice care in the area of AD. It might provide an effective tool for palliative care nurses to communicate with family caregivers of persons with AD at the end of life.
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Affiliation(s)
- Pnina Sela-Katz
- Registered Nurse, Department of Gerontology, University of Haifa, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Israel
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Phongtankuel V, Adelman RD, Reid MC. Mobile health technology and home hospice care: promise and pitfalls. PROGRESS IN PALLIATIVE CARE 2018; 26:137-141. [PMID: 30505077 DOI: 10.1080/09699260.2018.1467109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
With the increasing use of mobile devices (e.g., smart phones, tablets) in our everyday lives, people have the ability to communicate and share information faster than ever before. This has led to the development of promising applications aimed at improving health and healthcare delivery for those with limited access. Hospice care, which is commonly provided at home, may particularly benefit from the use of this technology platform. This commentary outlines several potential benefits and pitfalls of incorporating mobile health (mHealth) applications into existing home hospice care while highlighting some of the relevant telemedicine work being done in the palliative and End-of-Life care fields.
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Affiliation(s)
- Veerawat Phongtankuel
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronald D Adelman
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - M C Reid
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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Shalev A, Phongtankuel V, Kozlov E, Shen MJ, Adelman RD, Reid MC. Awareness and Misperceptions of Hospice and Palliative Care: A Population-Based Survey Study. Am J Hosp Palliat Care 2017. [PMID: 28631493 DOI: 10.1177/1049909117715215] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the documented benefits of palliative and hospice care on improving patients' quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients' and caregivers' lack of knowledge and misperceptions. OBJECTIVES To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults. DESIGN Cross-sectional study. SUBJECTS New York State residents ≥18 years old who participated in the 2016 Empire State Poll. OUTCOMES MEASURED Palliative and hospice care awareness, misperceptions, and receptivity. RESULTS Of the 800 participants, 664 (83%) and 216 (27%) provided a definition of hospice care and palliative care, respectively. Of those who defined hospice care, 399 (60%) associated it with end-of-life care, 89 (13.4%) mentioned it was comfort care, and 35 (5.3%) reported hospice care provides care to patients and families. Of those who defined palliative care (n = 216), 57 (26.4%) mentioned it provided symptom management to patients, 47 (21.9%) stated it was comfort care, and 19 (8.8%) reported it was applicable in any course of an illness. Of those who defined hospice or palliative care, 248 (37.3%) had a misperception about hospice care and 115 (53.2%) had a misperception about palliative care. CONCLUSIONS Most community-dwelling adults did not mention the major components of palliative and hospice care in their definitions, implying a low level of awareness of these services, and misinformation is common among community-dwelling adults. Palliative and hospice care education initiatives are needed to both increase awareness of and reduce misperceptions about these services.
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Affiliation(s)
- Ariel Shalev
- 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Elissa Kozlov
- 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Ronald D Adelman
- 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - M C Reid
- 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Nahapetyan L, Orpinas P, Glass A, Song X. Planning Ahead: Using the Theory of Planned Behavior to Predict Older Adults’ Intentions to Use Hospice if Faced With Terminal Illness. J Appl Gerontol 2017; 38:572-591. [DOI: 10.1177/0733464817690678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hospice is underutilized in the United States, and many patients enroll for short periods of times. The purpose of this cross-sectional study was to identify significant predictors of intentions to use hospice in community-dwelling older adults. The Theory of Planned Behavior informed the selection of predictors. Data were collected from 146 White older adults ( M age = 69.5; 69% females). Multiple linear regression analyses showed that higher hospice knowledge, normative beliefs that support hospice utilization, higher perceived control to use hospice, and preferences for end-of-life care that favor comfort and quality of life over living as long as possible were significant predictors of intentions to use hospice. In spite of being a sample of mostly highly educated older adults, almost half did not know about funding for hospice. These results provide better understanding of where to focus interventions to educate older adults about hospice, ideally in advance of a crisis.
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Affiliation(s)
| | | | - Anne Glass
- University of North Carolina Wilmington, USA
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O’Connor M, Brennan B, Bloomer MJ, Shimoinaba K. Vulnerability at the End of Life. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2014. [DOI: 10.1177/1084822313514978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Australia, veterans are a vulnerable group, because of ageing, and high rates of chronic or life-threatening illnesses and poor mental health .This retrospective pilot study explored the home-based palliative care needs of veterans as they face the end of their life, compared to non-veterans. Medical records of ten deceased veterans and ten non-veterans in a home-based palliative care service were analyzed both for demographic data, and qualitative content. Veterans had significantly more comorbidities and were older at death. Qualitative data indicated common concerns, including the role of families and practical aspects of care. Some differences were found between veterans and non-veterans in their end-of-life care requirements. More awareness of veterans’ status may assist in care more tailored to their specific needs.
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Frahm KA, Brown LM, Hyer K. Racial Disparities in Receipt of Hospice Services Among Nursing Home Residents. Am J Hosp Palliat Care 2013; 32:233-7. [DOI: 10.1177/1049909113511144] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the relationship between race and advance care planning, hospitalization, and death among nursing home residents receiving hospice care. Secondary data analysis using the 2007 Minimum Data Set (MDS) was used to identify documentation of these activities for White, Black, Hispanic, and Asian residents with linear regression models fitted to each dependent variable. Across different types of advance directives, compared to White nursing home residents, Black, Hispanic, and Asian residents who received hospice services were significantly less likely overall to have documented advance directives. All racial groups were also more likely to experience hospitalization while on hospice, regardless of whether they had a documented “do not hospitalize” order. As nursing homes become more diverse, recognizing differences in hospice use and end-of-life planning will continue to increase in importance.
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Affiliation(s)
- Kathryn A. Frahm
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Lisa M. Brown
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Kathryn Hyer
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Final decisions: how hospice enrollment prompts meaningful choices about life closure. Palliat Support Care 2013; 12:211-21. [PMID: 23942112 DOI: 10.1017/s1478951512001113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to explore and describe decisions that faced newly enrolled hospice patients and their caregivers after hospice enrollment. METHOD An exploratory, descriptive, cross-sectional design was employed using qualitative methods. In-depth in-person interviews were conducted with current hospice patients (n = 35) and caregivers (n = 45) from 53 families. RESULTS The decision to enroll in hospice was a critical juncture on the trajectory of a terminal illness that allowed patients and their families an opportunity to consider subsequent tasks that were important for life closure. A typology of five decisions is presented: (1) operationalized advance care planning (ACP): a renewed focus on decisions about care at life's end; (2) surrogate decision-making: caregivers begin making both informal and formal decisions for the dying person; (3) meaning-making: the foreshortened time brings into focus decisions about seeing special people, attending events, and creating memories; (4) Location of death: decisions about whether the person wants to and can remain at home to die; and (5) final acts: decisions about funeral arrangements, wills, and leaving a legacy become central. ACP was found to exist on a continuum that ranged from absent ACP, dormant ACP, simplified ACP to activated ACP. Hospice enrollment became a catalyst for reactivating discussion of end-of-life choices. SIGNIFICANCE OF RESULTS Hospice enrollment prompts the need to consider subsequent important choices that contribute to meaningful life closure, are central to the completion of a family relationship, and may influence adaptation in bereaved caregivers. It is important for clinicians to recognize that well-timed encouragement to consider and explore the use of hospice services, although it may indeed diminish hope for cure or recovery, simultaneously offers an opportunity to engage with important and time-sensitive developmental tasks.
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9
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Racial Disparities in End-of-Life Planning and Services for Deceased Nursing Home Residents. J Am Med Dir Assoc 2012; 13:819.e7-11. [DOI: 10.1016/j.jamda.2012.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/22/2012] [Accepted: 07/31/2012] [Indexed: 11/22/2022]
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Manu E, Mack-Biggs TL, Vitale CA, Galecki A, Moore T, Montagnini M. Perceptions and Attitudes About Hospice and Palliative Care Among Community-Dwelling Older Adults. Am J Hosp Palliat Care 2012; 30:153-61. [PMID: 22556283 DOI: 10.1177/1049909112445305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It is expected that the American geriatric population will have an increased need for hospice and palliative care services over the next few decades. We surveyed 187 community dwelling older adults about several aspects related to end-of-life (EOL) care. Participants were much more familiar with the term hospice than palliative care. In general, they had positive attitudes towards hospice and palliative care. Although experience caring for a dying relative was common, it wasn't associated with better attitudes towards hospice and palliative care or better familiarity with these terms. Familiarity with the term palliative care was associated with better attitudes towards EOL care. Our findings highlight the need for enhanced end-of-life care education among older adults, and reinforce the need for further research in this area.
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Affiliation(s)
- Erika Manu
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | | | - Caroline A. Vitale
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - Andrej Galecki
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Tisha Moore
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Marcos Montagnini
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
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Choi JE, Miyashita M, Hirai K, Sato K, Morita T, Tsuneto S, Shima Y, Kim BH. Making the Decision for Home Hospice: Perspectives of Bereaved Japanese Families who had Loved Ones in Home Hospice. Jpn J Clin Oncol 2012; 42:498-505. [DOI: 10.1093/jjco/hys036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Dussen DV, Culler KL, Cagle JG. Perceptions about hospice from a community-based pilot study: lessons and findings. Am J Hosp Palliat Care 2011; 28:418-23. [PMID: 21208898 DOI: 10.1177/1049909110394339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Research investigating the knowledge and attitudes of diverse older adults about hospice care and end-of-life issues is needed to expand service utilization. This pilot study explored an urban area's perceptions and awareness of hospice through local churches. The sample consisted of 148 adults age 43 and older. Although recruitment efforts resulted in a relatively homogenous sample, findings suggest a lack of knowledge about whether hospice is covered by Medicare, Medicaid, or private insurance. Perceptions of the expense of hospice, however, were not associated with knowledge of coverage. Respondents generally agreed that hospice is important and would recommend its services for their family members.
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Affiliation(s)
- Daniel Van Dussen
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, OH 44555, USA.
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13
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Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in self-reported exposure to information about hospice care. J Palliat Med 2010; 12:921-7. [PMID: 19807237 DOI: 10.1089/jpm.2009.0066] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous research suggests that lack of knowledge of hospice is a barrier to the use of hospice care by African Americans. However, there is little data examining racial differences in exposure to hospice information. OBJECTIVES Examine racial differences in self-reported exposure to hospice information and determine how this exposure impacts beliefs about hospice care. METHODS We surveyed 200 community-dwelling older adults (65 or older). We used Spearman's correlations to examine the relationship between responses to individual items on the Hospice Beliefs and Attitudes Scale (HBAS) and self-reported exposure to hospice information (never heard of hospice, heard a little, or heard a lot). We used multivariate analyses to examine predictors of exposure to hospice information and beliefs about hospice care (total score on HBAS). RESULTS Compared to whites (n = 95), African Americans (n = 105) reported significantly less exposure to hospice information (p = 0.0004). Nineteen percent of African Americans and 4% of whites had never heard of hospice; 47.6% of African Americans and 71.6% of whites had heard a lot about hospice. In multivariate analysis controlling for demographics and health status, African Americans had a two times higher odds of reporting that they had never heard of hospice or heard only a little about hospice versus heard a lot about hospice (odds ratio [OR] = 2.24 [1.17, 4.27]. Greater exposure to hospice information was associated with more favorable beliefs about hospice care (outcome: total score on HBAS; parameter estimate 1.34, standard error 0.44, p = 002). CONCLUSIONS African Americans reported less exposure to information about hospice than whites. Greater exposure to hospice information was associated with more favorable beliefs about some aspects of hospice care. Because knowledge is power, educational programs targeting older African Americans are needed to dispel myths about hospice and to provide minorities with the tools to make informed choices about end-of-life care.
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Affiliation(s)
- Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC 27710, USA.
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Ruff H, Jacobs RJ, Fernandez M, Bowen GS, Gerber H. Factors Associated With Favorable Attitudes Toward End-of-Life Planning. Am J Hosp Palliat Care 2010; 28:176-82. [DOI: 10.1177/1049909110382770] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Planning for end-of-life (EOL) care can result in better patient outcomes and lowered health care costs. We hypothesized that knowledge and experiences with EOL care would influence patients’ EOL planning (i.e., health care decisions, hospice use). Using an observational, cross-sectional design, we recruited a community sample of 331 South Floridians aged 18 to 84 (M = 44 years, SD = 14.95) to complete a questionnaire examining knowledge and opinions on EOL issues. Regression analyses showed that prior knowledge of living wills and hospice services were associated with more favorable attitudes toward hospice care, preference for limited medical interventions at EOL, and more comfort in communicating about death and dying. Patient education on EOL care may increase hospice use, enhance EOL planning, and improve patient outcomes.
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Affiliation(s)
- Heather Ruff
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | | | | | - Hilary Gerber
- Nova Southeastern University, Fort Lauderdale, FL, USA
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Abstract
BACKGROUND Exploring preferences for and barriers to quality end-of-life care is essential to improving care for dying individuals. Young adults often are involved or will be involved in decisions about the care of a loved one, and little research has examined opinions about end-of-life care among this population. RESEARCH OBJECTIVES The current study examined factors that may affect young adults' opinions about hospice care and home death. METHODS Participants were 1035 introductory psychology students at a southeastern university. The sample was 66% female and 60% Caucasian. The study questionnaire assessed participants' knowledge about hospice, experience with the death of a loved one, and opinions about hospice care and home death. RESULTS Approximately 44% of the sample reported experience with the death of a loved one from a terminal illness. Hospice knowledge was higher among females, and females were more likely to report a positive opinion about hospice care as well as a greater likelihood of recommending hospice services for a loved one. Caucasians had a more positive opinion of home death than African Americans. Individuals describing their prior experience with the death of a loved one as negative had a more positive opinion of home death than those with no prior experience or a non-negative experience. CONCLUSIONS Young adults' opinions about hospice and home death vary significantly with respect to gender and race. Large percentages of neutral responses suggest that interventions targeted at young adults could significantly impact their views of and ultimate choices about of end-of-life care.
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Affiliation(s)
- Nicole M Webb
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama 35295, USA.
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Running A, Shumaker N, Clark J, Dunaway L, Tolle LW. Veteran preferences for end-of-life care. Int J Older People Nurs 2009; 4:41-7. [DOI: 10.1111/j.1748-3743.2008.00134.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Supiano KP, Gregory J. Transitions of Care: Optimal Communication Between Hospital and Hospice. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2008. [DOI: 10.1177/1084822307311830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article, the key elements of a successful transition of terminally ill patients from the inpatient hospital to home hospice care setting are described. This article describes the role and responsibilities inpatient palliative care teams and receiving hospice agencies have for communicating with patients and families and preparing them for hospice care. This article explains one approach to educating the varied members of the health care team and describes how to collaborate on care plans to facilitate an effective and satisfying transfer of care.
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Vig EK, Taylor JS, Starks H, Hopley EK, Fryer-Edwards K. Beyond Substituted Judgment: How Surrogates Navigate End-of-Life Decision-Making. J Am Geriatr Soc 2006; 54:1688-93. [PMID: 17087695 DOI: 10.1111/j.1532-5415.2006.00911.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To characterize how surrogates plan to make medical decisions for others. DESIGN Descriptive study using semistructured qualitative interviews. SETTING Surrogates were interviewed by telephone from their homes. PARTICIPANTS Fifty experienced surrogate decision-makers identified to make decisions for older, chronically ill veterans. MEASUREMENTS Surrogates were asked to describe advance care planning conversations with loved ones and how they planned to make future medical decisions. Thematic content analysis was used to identify bases for decision-making. RESULTS Surrogates described the motivators and the content of advance care planning conversations with loved ones. Surrogates described five bases for decision-making: (1) conversations (making decisions based on their knowledge of their loved ones' preferences), (2) relying on documents (referring to their loved ones' advance care directives), (3) shared experience (believing an "inner sense" would guide decisions because of shared lived experience with loved ones), (4) surrogates' own values and preferences about life, and (5) surrogates' network (enlisting the help of others). CONCLUSION Although ethicists and clinicians expect surrogates to use substituted judgment or patients' best interests when making decisions, these data indicate that many surrogates rely on other factors such as their own best interests or mutual interests of themselves and the patient or intend to base substituted judgments on documents with which they have little familiarity.
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Affiliation(s)
- Elizabeth K Vig
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA.
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