Advance Care Planning and Hospice Enrollment: Who Really Makes the Decision To Enroll?

Hirschman, Karen B.; Corcoran, Amy M.; Straton, Joseph B.; Kapo, Jennifer

doi:10.1089/jpm.2009.0370

Cited by 22 publications

(20 citation statements)

References 15 publications

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“…Other research indicates that it is important to involve the patient in the decision-making process because patients differ in their treatment preferences and need for personal control (27). In our study, only 17% of participants reported that the final decision was made by medical staff alone, slightly lower than the proportions reported in previous studies (23,26,28). This difference may be due to cultural differences of the society.…”

Section: Discussioncontrasting

confidence: 90%

Making the Decision for Home Hospice: Perspectives of Bereaved Japanese Families who had Loved Ones in Home Hospice

Choi¹,

Hirai²,

Sato³

et al. 2012

Japanese Journal of Clinical Oncology

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Objective: The aim of the study was to evaluate whether family members believed that the decision for home hospice had been the acceptable choice and to identify factors related to families accepting that the decision was good. Methods: In June 2007, a cross-sectional anonymous questionnaire was distributed to bereaved family members of terminal cancer patients in Japan who died at home in the previous 6 months. The questionnaire included questions about whether the family member believed that the decision for home hospice had been the acceptable choice and the decision-making process. Results: A total of 286 responses from 14 home hospices were analyzed. A total of 92% of the participants indicated that the decision for home hospice had been the acceptable choice. Multivariate logistic regression analysis indicated that the following subjects were more likely to believe that the decision for home hospice had been the acceptable choice: those who (i) considered the patient's desire ahead of the family situation (P , 0.001); (ii) decided based on knowledge of all options (P , 0.001); (iii) decided based on agreement with patient, family and medical staff (P ¼ 0.007); (iv) decided based on the patient and family only (P ¼ 0.026); and (v) had patients who were enrolled in home hospice for ,60 days (P ¼ 0.032). Conclusions: It is important to encourage discussion about end-of-life care and to assist the patient and family in the decision-making process by providing information on all available options through open communication.

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Section: Discussioncontrasting

confidence: 90%

Making the Decision for Home Hospice: Perspectives of Bereaved Japanese Families who had Loved Ones in Home Hospice

Choi¹,

Hirai²,

Sato³

et al. 2012

Japanese Journal of Clinical Oncology

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“…40 Furthermore, almost half (49%) of family members of patients who died in one universityaffiliated hospice (n = 165) reported that the patient was not involved in hospice enrollment decisions. 27 Interventions to improve the timing and appropriateness of hospice referral to maximize the full benefits of hospice must include patients and their families. The association we found between educational attainment discordance of spouse and hospice use may be reflective of socioeconomic status, health literacy, realistic expectations about death, or knowledge about hospice.…”

Section: Discussionmentioning

confidence: 99%

“…16 While lack of hospice utilization or underutilization may be attributable to documented differences in patient characteristics (e.g., diagnosis, race, ethnicity, and income [17][18][19][20][21][22], and geographic region (e.g., hospice resources available, variation in services hospices provide [23][24][25] ), the decision-making process regarding hospice enrollment is often based within the family unit. 22,[26][27][28][29] While the family has a crucial role in determining hospice utilization, little is known about how family characteristics are associated with the decision to use hospice.…”

Section: Introductionmentioning

confidence: 99%

Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care

Ornstein

Aldridge

Mair

et al. 2016

Journal of Palliative Medicine

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Background: Hospice use has been shown to benefit quality of life for patients with terminal illness and their families, with further evidence of cost savings for Medicare and other payers. While disparities in hospice use by patient diagnosis, race, and region are well documented and attention to the role of family members in endof-life decision-making is increasing, the influence of spousal characteristics on the decision to use hospice is unknown. Objectives: To determine the association between spousal characteristics and hospice use. Design: We used data from the Health and Retirement Study (HRS), a prospective cohort study, linked to the Dartmouth Atlas of Health Care and Medicare claims. Setting: National study of 1567 decedents who were married or partnered at the time of death (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). Measures: Hospice use at least 1 day in the last year of life as measured via Medicare claims data. Spousal factors (e.g., education and health status) measured via survey. Results: In multivariate models controlling for patient factors and regional variation, spouses with lower educational attainment than their deceased spouse had decreased likelihood of hospice use (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40-0.82). Health of the spouse was not significantly associated with likelihood of decedent hospice use in adjusted models. Implications: Although the health of the surviving spouse was not associated with hospice use, their educational level was a predictor of hospice use. Spousal and family characteristics, including educational attainment, should be examined further in relation to disparities in hospice use. Efforts to increase access to high-quality end-of-life care for individuals with serious illness must also address the needs and concerns of caregivers and family.

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“…Overall involvement of various disciplines, patients and family was high in the 18 ACP meetings that were documented. Hirschman, Corcoran, Straton, & Kapo (2010) found in their study of 165 hospice patients, nearly 65.5% had an AD. In this present study, only seven patients were receiving hospice care.…”

Section: Chapter 5 Discussionmentioning

confidence: 92%

A Retrospective Study Describing Documentation of Advance Care Planning in a Long Term Care Setting

Linder¹

2013

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Problem: Increased life expectancy and aging baby boomers will increase the population of those 65 years of age and older to nearly 20% of the United States population by 2030.It is estimated that 40-70% of this population will need long term care during their lifetime, and by 2020, 40% of patients in long term care will die there. As patients age, advance care planning (ACP) and advance directives (AD) should be completed to make their wishes known to healthcare providers and family. Despite legal requirements for completion at entry to healthcare settings, less than 95% of hospitalized patients and 50%of long term care patients have an AD or ACP.Significance: Advance care planning increases patients' quality of life, may decrease stress and ease decision making at end of life for patients and families. There is little research on the completion levels of ACP in long term care. Purpose:The primary purpose of this retrospective study is to describe the level of ACP documentation in a long term care setting. A secondary purpose is to describe potential relationships between demographic, past medical history (PMH) and ACP variables Design: Retrospective descriptive chart reviewResults: More than 76% of patients at the facility were over the age of 65. Less than 43% of patients had an AD listed in their chart, and less than 31% of patients had an AD completed prior to admission at the long term care facility. At admission to the facility, only 7 of 29 (12.7%) patients that came from the hospital had an AD or ACP documented. Seven patients at the facility were listed as Hospice patients, and only three of seven (42.8%) had ACP documented. Only 33% of patients had an ACP meeting at the facility listed in their chart. Of ACP meetings that occurred, there was a high level of patient and family involvement in end of life decision making. A correlation was found iii between Alzheimer's disease and ACP completion, as well as Medicaid insurance and ACP completion.

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Advance Care Planning and Hospice Enrollment: Who Really Makes the Decision To Enroll?

Cited by 22 publications

References 15 publications

Making the Decision for Home Hospice: Perspectives of Bereaved Japanese Families who had Loved Ones in Home Hospice

Making the Decision for Home Hospice: Perspectives of Bereaved Japanese Families who had Loved Ones in Home Hospice

Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care

A Retrospective Study Describing Documentation of Advance Care Planning in a Long Term Care Setting

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