Viewing Hospice Decision Making as a Process

Romo, Rafael D.; Wallhagen, Margaret; Smith, Alexander K.

doi:10.1177/1049909115569592

Cited by 19 publications

(23 citation statements)

References 66 publications

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“…Moreover, evidence of the influence of health literacy on hospice decision‐making is scarce. Because hospice decision‐making is an evolving process, the decision may change over time, as the health condition declines, or as disease control deteriorates (Romo, Wallhagen, & Smith, ). Therefore, periodic counselling with regard to decisions about end‐of‐life care for elderly patients with a life expectancy of less than 10 years, or at least by the age of 85, has been suggested (Smith, Williams, & Lo, ).…”

Section: Introductionmentioning

confidence: 99%

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

Huang

Kuo

et al. 2019

Health Soc Care Community

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The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community‐dwelling elderly participants. This cross‐sectional study enrolled 990 community‐dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer‐administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.

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Section: Introductionmentioning

confidence: 99%

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

Huang

Kuo

et al. 2019

Health Soc Care Community

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“…These data build on efforts to initiate hospice introductory discussions and visits earlier on in care. 25 Results align with suggestions that enrolling in hospice is a process more than an isolated decision 26 and that the end of cancer treatment may be a turning point in hospice decision making. 27 Our findings further suggest potential benefits of refining supportive interventions to align with or target the ways in which communication shifts for patients and families and their clinicians in concert with patient health status.…”

Section: Discussionmentioning

confidence: 54%

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

Traeger

Rapoport

Wright

et al. 2020

Journal of Palliative Medicine

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Background: Patient/clinician communication is critical to quality cancer care at the end-of-life (EOL). Yet discussions about systemic therapy discontinuation or hospice as a care option are commonly deferred. Realtime communication about these complex topics has not been evaluated. Palliative care visits may provide useful insight into how communication about EOL care occurs over time. Objective: To explore the nature of discussions about systemic therapy discontinuation and hospice among patients, families, and palliative care clinicians during care for incurable cancer. Design: Qualitative study of palliative care visits. Setting/Subjects: We audiorecorded visits of patients and families who participated in a palliative care trial from diagnosis of incurable lung or noncolorectal gastrointestinal cancer through the course of cancer care (n = 30). Measurements: We used thematic analysis to characterize communication patterns in the context of clinical events. Results: Content and tenor of discussions shifted in relation to patient health status. In the absence of acute medical deterioration, discussions addressed hospice broadly as an EOL care option. Candid exchanges between patients and families and their clinicians supported increasing depth and specificity of EOL care communication. As clinicians identified that patients were not tolerating treatment, the clinicians encouraged contemplation about quality-of-life implications of continuing treatment or the possibility that treatment might harm more than help, in anticipation of change in health status. Conclusions: Longitudinal relationships with palliative care clinicians functioned through multiple pathways to support patients and families in making complex EOL care decisions. Results inform models and interventions of communication at the EOL.

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“…This highlights an additional use for prognostication, expanding on recent proposals that have focused on using prognostic estimates to prompt scaling back on interventions. 3,14,26 The examples provided by clinicians in our study also call attention to the choice clinicians sometimes face in deciding whether clinical decline or risk is reversible, and if so, how interventions might impact health outcomes. In this way, prognosis can be seen as dynamic, with the circumstances contributing to prognosis having the potential to change over time.…”

Section: Discussionmentioning

confidence: 93%

Defining the Scope of Prognosis: Primary Care Clinicians' Perspectives on Predicting the Future Health of Older Adults

Thomas

Fried

2018

Journal of Pain and Symptom Management

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Viewing Hospice Decision Making as a Process

Cited by 19 publications

References 66 publications

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors

Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study

Defining the Scope of Prognosis: Primary Care Clinicians' Perspectives on Predicting the Future Health of Older Adults

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