SEARCH · PubMed Health

Results for “hospice”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed1998

An update on efforts by the hospice community and the National Hospice Organization to improve access to quality hospice care.

More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.

Health Services Accessibility↗

PubMed2004

Measuring hospice care: the National Hospice and Palliative Care Organization National Hospice Data Set.

Hospice has seen rapid growth in recent years, but there is a lack of consistency among hospices when it comes to compliance with standards of care. Consequently, hospices vary in performance and in services they provide. With state hospice organizations, the NHPCO developed a National Data Set (NDS) intended to understand demographics, practices, and outcomes; illustrate industry effectiveness; facilitate communication of industry legislative needs; and to support agency performance and improvement. Our paper describes development of the NDS and data that are being collected, and summarizes key findings from the 2000, 2001, and 2002 NDS. The data collection process, which began in 1999, has evolved substantially over a 4-year period to the point that we believe the 2002 NDS represents a well-designed core that will receive only minor modifications annually. This database will be invaluable for comparative audit, clinical practice and managing services because only that which is measured can be improved.

Data Collection↗

PubMed2003

How does the timing of hospice referral influence hospice care in the last days of life?

OBJECTIVES: To determine factors associated with the type of hospice care received in the last days of life and, in particular, how the timing of referral influences the use of continuous hospice home care and inpatient hospice care. DESIGN: Retrospective cohort study. SETTING: Twenty-one hospice programs across seven states under the ownership of one hospice parent provider. PARTICIPANTS: Hospice patients who were cared for and died between October 1, 1998, and September 30, 1999 (N = 28,747). MEASUREMENTS: Patient sociodemographic and clinical data were merged with use data from the provider's centralized information system to examine the factors associated with the differing levels of hospice care in the last week of life. In the last days of life, patients were classified as having received routine hospice home care only, having received continuous hospice home care, or having died in an inpatient hospice bed. RESULTS: Twenty-three percent of the patients received continuous hospice home care during the last week of life, and 34% died in an inpatient hospice bed. Patients with hospice stays of less than 7 days had a lower likelihood of receiving continuous hospice home care than those who had stays of more than 30 days (adjusted odds ratio (AOR) = 0.81, 95% confidence interval (CI) = 0.75-0.87). Patients with hospice stays of 14 days or less had a greater likelihood of dying in an inpatient hospice bed. Furthermore, patients with stays of less than 7 days who were referred from hospitals were six times likelier to die in an inpatient hospice bed than those who were referred from another source (AOR = 6.40, 95% CI = 5.74-7.14). Patients in nursing homes had a 93% lower likelihood of dying in an inpatient hospice bed than patients in the community without a live-in caregiver (AOR = 0.07, 95% CI = 0.03-0.19). Strong independent associations were observed between several other covariates and the study outcomes, particularly the covariates of which state hospice care was provided in and level of pain intensity. CONCLUSION: Findings suggest that continuous hospice home care in the last week of life is less likely to occur when patients have short hospice stays. Also, the probability of dying in an inpatient hospice bed is substantially greater for patients referred from hospitals and referred closer to time of death. Further work to determine the appropriateness of use of the different levels of hospice care is needed.

Aged↗

PubMed2005

Access to nursing home hospice: perspectives of nursing home and hospice administrators.

BACKGROUND AND OBJECTIVES: Hospice improves the quality of end of life care in nursing homes but serves less than 10% of dying residents. For residents to elect hospice, nursing homes must first contract for these services. We surveyed nursing home and hospice administrators to describe facilitators and barriers to hospice in nursing homes, and to test whether nursing home administrators' attitudes correlate with hospice use. METHODS: In a mailed survey, all nursing home and hospice administrators in North Carolina responded to items on hospice's effect on quality of care, and on facilitators and barriers to its use in nursing homes. Among nursing home administrators, bivariate analyses were used to test associations of attitudes with use of hospice. RESULTS: After 2 mailings, 241 (62%) nursing home administrators and 74 (85%) hospice administrators responded. Eighty-three percent of nursing homes had a hospice contract, with a median of 3 residents enrolled in the last 3 months. Nursing home administrators were less likely than hospice administrators to believe that hospice improves quality of care for pain, emotional and spiritual needs, and bereavement support. Nursing home administrators were more likely to agree that, "Nursing homes provide good care without using hospice for dying residents and their families," (24% versus 1%, p < 0.001). Among nursing home administrators with a hospice contract (n = 180), those who agreed that hospice improves quality of care had higher rates of hospice use in their facilities. CONCLUSIONS: Nursing home administrators' attitudes toward hospice may influence its availability for nursing home residents.

Adult↗

PubMedDate not supplied

Predictors of live hospice discharge: data from the National Home and Hospice Care Survey (NHHCS).

In the context of the current regulatory environment, patients may be discharged from hospice if their condition stabilizes or improves over time and the certifying physician is unable to provide a conscientious recertification of the six-month prognosis. Little is known about the characteristics or outcomes of patients who are determined by physicians to no longer be eligible for hospice care. This retrospective study was designed to characterize the rates and predictors of live hospice discharge using data from the 1996 and 1998. National Home and Hospice Care Survey (NHHCS). We compare records of live hospice discharge with hospice discharges due to death from the discharge patient files of the 1996 and the 1998 NHHCS. Of the 807,733 patients in the combined 1996 and 1998 NHHCS discharge patient file who met study inclusion criteria, 761,858 (94 percent) were deceased and 45,875 (6 percent) were discharged alive. Those who were discharged alive were more likely to be female, have received hospice care for more than 60 days, and to have had a noncancer diagnosis, particularly advanced cardiopulmonary or neurologic disease. Mean age and total number of assistive medical devices used did not differ significantly between patients who were discharged alive and those who died in hospice care. Factors most associated with live hospice discharge, using bivariate analyses, were length of service greater than 60 days (OR, 6.60; 95 percent CI, 6.47-6.73), cardiopulmonary diagnosis (OR, 3.24; 95 percent CI, 3.19-3.30), and neurologic diagnosis (OR, 2.73; 95 percent CI, 2.67-2.79). Multivariate logistic regression identified length of service greater than 60 days, cardiopulmonary diagnosis, neurologic diagnosis, female gender, worse functional status, and living in an institutional setting as being independently associated with live hospice discharge. We found that patients who were discharged alive from hospice care were more likely to have longer lengths of service, noncancer diagnoses, and better functional status than those who died while receiving hospice care. Age was not associated with discharge disposition. Given the demonstrated differences between these patients and those who died while receiving hospice care, these data provide further impetus for careful study of the appropriateness of current hospice eligibility criteria, the determinants of hospice discharge and, most important, the outcomes of patients who are discharged alive from hospice and the impact of hospice discharge on patients and their families.

Adolescent↗

PubMed2004

Hospice admission practices: where does hospice fit in the continuum of care?

OBJECTIVES: To evaluate selected hospice admission practices that could represent barriers to hospice use and the association between these admission practices and organizational characteristics. DESIGN: From December 1999 to March 2000, hospices were surveyed about selected admission practices, and their responses were linked to the 1999 California Office of Statewide Health Planning and Development's Home and Hospice Care Survey that describes organizational characteristics of California hospices. SETTING: California statewide. PARTICIPANTS: One hundred of 149 (67%) operational licensed hospices. MEASUREMENTS: Whether hospices admit patients who lack a caregiver; would not forgo hospital admissions; or are receiving total parenteral nutrition (TPN), tube feedings, radiotherapy, chemotherapy, or transfusions. RESULTS: Sixty-three percent of hospices restricted admission on at least one criterion. A significant minority of hospices would not admit patients lacking a caregiver (26%). Patients unwilling to forgo hospitalization could not be admitted to 29% of hospices. Receipt of complex medical care, including TPN (38%), tube feedings (3%), transfusions (25%), radiotherapy (36%), and chemotherapy (48%), precluded admission. Larger program size was significantly associated with a lower likelihood of all admission practices except restricting the admission of patients receiving TPN or tube feedings. Hospice programs that were part of a hospice chain were less likely to restrict the admission of patients using TPN, radiotherapy, or chemotherapy than were freestanding programs. CONCLUSION: Patients who are receiving complex palliative treatments could face barriers to hospice enrollment. Policy makers should consider the clinical capacity of hospice providers in efforts to improve access to palliative care and more closely incorporate palliation with other healthcare services.

Caregivers↗

PubMed1995

Access to hospice programs in end-stage dementia: a national survey of hospice programs.

OBJECTIVE: Because care of end-stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients. DESIGN: A survey of 1694 hospices with 1184 respondents (70%). PATIENTS: Identified patients had end-stage dementia, with no concurrent terminal illness. MEASURE: The proportion of end-stage dementia patients in hospice was measured. RESULTS: Fewer than 1% of hospice patients had a primary diagnosis of end-stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for-profit hospices served dementia patients (42%) compared with non-profit programs (22%) or public programs (15%), P < .001. CONCLUSIONS: A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospices care unfeasible. Similarly, the high proportion of for-profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end-stage dementia.

Dementia↗

PubMedDate not supplied

Not ready for hospice: characteristics of patients in a pre-hospice program.

CONTEXT: There are many patients with terminal illness for whom hospice care would be appropriate, but they either never enroll or enroll very late. In a pre-hospice program designed to help patients make the transition into hospice, we observed that many patients did not make the transition. OBJECTIVES: To understand more about the transition to hospice and the functions of a pre-hospice program, this paper compares patients who enrolled in hospice with those who died in the pre-hospice program. DESIGN, SETTING, AND PATIENTS: Data were collected from a retrospective review of the charts of 123 consecutive patients who enrolled in a prehospice program between January 1, 1995, and December 31, 1996. MAIN OUTCOME MEASURES: The patient's decision to transfer to home hospice or (perhaps, by not making a decision) to remain enrolled in the pre-hospice program until death. RESULTS: At the end of the research period, 38 patients had transferred to hospice and 36 had died without transfer. The remaining 49 patients had uncertain outcomes at the end of the research period. Patients who transferred to hospice were older (P = .02) and more likely to have secondary insurance (P = .05). In addition, those who enrolled in hospice were more likely to live alone (P = .03) and have psychosocial concerns noted by staff on admission (P = .05). CONCLUSIONS: Many patients died in this program that was designed only for transition to hospice. We found statistically significant differences characterizing the groups associated with transferring to hospice. Further studies to find out why these differences exist will be important in order to provide excellent end-of-life care for more people.

Adaptation, Psychological↗

PubMed2005

A national survey of health professionals and volunteers working in voluntary hospice services in the UK. I. Attitudes to current issues affecting hospices and palliative care.

This paper reports results from a national survey in 1999 of voluntary hospice services in the UK. It focuses on volunteer and staff views of the purposes of hospice care, and on current debates within palliative care. Twenty-five hospice services, stratified by region, services provided (inpatient care, day care and/or home care) and number of beds were randomly sampled from amongst 175 voluntary hospices in the UK. Nineteen participated. Seventy per cent of a random sample of professional and voluntary staff within these hospices returned a postal questionnaire. Both volunteers and professionals considered care of the whole person, pain and symptom control, quality of life and dying peacefully to be important aspects of hospice care. Most doctors chose care of the whole person as the most important aspect, and they were more likely to choose this option than other staff. Hospice volunteers were less positive than hospice staff (particularly doctors and nurses) in their attitudes to extending hospice care to noncancer patients (where many volunteers held no strong view), to restricting care to patients with specialist palliative care needs, and less negative about euthanasia. These findings illustrate the importance of including hospice volunteers and the general public, as well as hospice staff, in debates about the future of hospice and palliative care in the UK. Further research is needed into lay and professional views of the role of hospices and palliative care services.

Adult↗

PubMed2005

A national survey of health professionals and volunteers working in voluntary hospices in the UK. II. Staff and volunteers' experiences of working in hospices.

In this paper we report findings of a 1999 nationally representative survey of independent hospices in the UK, focusing on hospice staff and volunteers' experiences of working in hospices. Nineteen of 25 sampled services participated, and these differed little in terms of service provision, size and region from the total sample of 175 services. A response rate of 70% for randomly sampled hospice staff and volunteers was achieved (n=504). There were significant intergroup differences (doctors, nurses, nursing auxiliaries, other staff and volunteers) in participants' reported experience of working in the hospice with, for example, doctors being more likely than other groups to feel appreciated and to report receiving adequate support from hospice management. Overall, 31% of respondents wanted more support from management. Half had considered leaving the hospice (65% nurses, 60% other staff, 55% nursing auxiliaries, 40% doctors and 37% volunteers). Nurses who had considered leaving were less satisfied than other nurses with, for example, support from hospice management, and less likely to feel valued by the hospice. These results raise questions about the quality of the relationship between hospice trustees, managers and staff, and about the realities of enhancing multiprofessional teamwork in organizations where there are significant differences between staff groups in perception of, and satisfaction with, the working environment. Voluntary hospice trustees and managers face a difficult task in managing and supporting staff whilst also negotiating relationships with the NHS at a time of rapid change, and ensuring hospices' financial viability. Access to high quality leadership programmes may play an important role in ensuring voluntary hospices are characterized by effective, supportive working relationships.

Adaptation, Physiological↗

PubMed2004

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.

BACKGROUND: The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. METHODS: Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. RESULTS: In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75). CONCLUSION: The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

Female↗

PubMed2005

Timing of hospice referral and families' perceptions of services: are earlier hospice referrals better?

OBJECTIVES: To determine whether families of patients who enroll in hospice near the end of life believe that they receive less benefit from hospice services than families of patients who enroll earlier. DESIGN: Semistructured interviews at the time of hospice enrollment and 1 month after the patient's death. SETTING: This study was conducted at the Hospice of Lancaster County, Lancaster, PA, over a 12-month period spanning 2003-2004. PARTICIPANTS: First-time hospice admissions. MEASUREMENTS: Interviews assessed the anticipated helpfulness of six hospice services (enrollment interviews) and the actual helpfulness of the same services (follow-up interviews). RESULTS: Length of stay in hospice was associated with families' reports of the number of services provided (Spearman rho=0.34, P<.001), and with the mean helpfulness ratings for the services that were provided (Spearman rho=0.34, P<.001), although even with short lengths of stay, most families reported that they received the services that they anticipated and that those services were helpful. CONCLUSION: These results indicate that families feel they receive greater benefits from longer lengths of stay in hospice. Future efforts to define an "optimal" length of stay in hospice should consider patients' and families' perceptions of the benefits that hospice offers.

Adult↗

PubMed2006

Access to hospice for African Americans: are they informed about the option of hospice?

OBJECTIVE: To examine whether African Americans are informed about hospice services, and to examine demographic or disease factors that may influence receipt of information about hospice. DESIGN: Retrospective cohort study. SETTING: Twenty-two states that accounted for nearly 70% of deaths in the United States in 2000. MEASUREMENTS: A mortality follow-back survey was conducted. Based on sampled death certificates from 22 states, informants listed on the death certificates were contacted by telephone regarding the decedent's dying experience. Among those persons not receiving hospice services, the respondents were asked if hospice was presented as an option for care at the end of life. RESULTS: Of 1578 interviews, 111 decedents were non-Hispanic, African Americans (average age, 71.5 years; 56% female). Of those, 32 (30.3%) of the decedents received hospice services, while 77 (68.5%) did not. Slightly more than half of African Americans (60; 53.8%) were not informed about hospice services and 12 (8.9%) were informed but did not enroll. Cancer sufferers were more likely to be counseled about hospice (p = 0.001). CONCLUSION: Slightly more than half of African Americans were not informed about hospice services, and of those who were informed, cancer was the leading cause of death. Information about hospice should be provided to patients regardless of diagnosis, and dissemination of information should be done aggressively in the African American community in an effort to make hospice a viable option for end-of-life care.

Black or African American↗

PubMedDate not supplied

Is there congruence in hospice nurses' view of their patients' quality of life and their hospice patients' view of their own quality of life?

Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change. This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care. Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses' priority in order to enhance the patients quality of life. Curtis and Fernsler explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses' view of the patients quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗

PubMed2002

The effect of inpatient hospice units on hospice use post-admission.

The objective of this study was to determine whether having a hospice unit within the hospital increases the proportion of terminally ill patients who use hospice services (including home, nursing home, or inpatient hospice) post-admission. Using medical record data abstracted for 232 randomly selected patients with terminal cancer admitted to six community hospitals in Connecticut, we found that patients admitted to a hospital with a hospice unit were more likely to use hospice services (i.e., home hospice, nursing home hospice, or inpatient hospice) post-admission than patients admitted to a hospital without a hospice unit (unadjusted OR 5.7, 95% CI 3.1, 10.6). This effect persisted after adjusting for patient age, gender, marital status, documented discussions of prognosis, prior hospice use, and type of cancer.

Aftercare↗

PubMedDate not supplied

[Development of hospice care service program about advanced cancer patient. I--The effect of hospice education programs on the death orientation].

The purpose of this study was to investigate what effect providing the hospice care team with hospice education programs had on the death orientation. The subjects of study were 28 volunteers, 14 nurses, 30 clergies who registered on hospice education programs from Aug. 6th, 1996 to May 20th, 1997. The data were analysed by descriptive analysis, ANOVA, Duncan test, paired t-test. The results of the study can be summarized as follows: 1. The degrees of death orientation were 85.70 in volunteers group, 84.31 in nurses group, and 73.00 in clergies group. So, clergies group has more positive death orientation than others (F = 6.33, p = .000). The degree of death orientation showed significant differences between age groups (F = 5.78, p = .002), and religiosity (t = 3.92, p = .000). There were no significant differences between the degree of death orientation and the others general characteristics of subjects. 2. The mean of death orientation was 80.04 before hospice education programs, but was 75.56 after hospice education programs (t = 3.92, p = .000). In conclusion, the subjects who received the hospice education programs showed the positive change in the degree of the death orientation. Therefore, it has been judged that education programs has been prerequisite in positive death orientation for hospice care. Furthermore, all of the hospice care members those who complete the hospice education program, will be performed efficient hospice care intervention for dying patients and their families.

Analysis of Variance↗

PubMed2003

Barriers to physicians' decisions to discuss hospice: insights gained from the United States hospice model.

Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.

Attitude of Health Personnel↗

PubMed2001

Family caregiving in hospice: effects on psychological and health functioning among spousal caregivers of hospice patients with lung cancer or dementia.

INTRODUCTION: Caregiving stress has been found to lead to depression and poor health among caregivers compared with age-matched non-caregiving controls. However, most of these studies have focused on dementia caregivers, and have not included hospice caregivers. The aim of this project was to assess the impact of caregiving stress on psychological and health functioning among spousal caregivers of hospice patients, in contrast to demographically matched non-caregiving controls. A secondary aim was to compare the caregiving stressors and psychological and health functioning between spousal caregivers of hospice patients with dementia versus lung cancer. METHODS: Forty spousal caregivers of hospice patients with dementia, and 40 spousal caregivers of hospice patients with lung cancer, were compared on admission to hospice, using measures of caregiving stressors, depression, life satisfaction, and physical health, with a sample of 40 demographically equated control subjects. RESULTS: Both groups of caregivers showed higher depression, lower life satisfaction and poorer physical health (p < .05) compared with non-caregivers. Over half of all caregivers evidenced clinically significant levels of depression, with rates of depression about three times the prevalence found in community samples of older adults. CONCLUSIONS: While family caregivers of hospice patients with dementia and lung cancer face very different objective stressors, the negative psychological and health impacts on the caregiver are marked and comparable across diagnosis. Hospice family caregivers are at high risk for both psychological and physical health disorders, and caregiver depression and health problems should be systematically assessed and treated by the hospice team.

Aged↗