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At the crossroads: Making the transition to hospice

Published online by Cambridge University Press:  19 July 2005

DENA SCHULMAN-GREEN
Affiliation:
School of Nursing, Center for Excellence in Chronic Illness Care, Yale University, New Haven, Connecticut
RUTH McCORKLE
Affiliation:
School of Nursing, Center for Excellence in Chronic Illness Care, Yale University, New Haven, Connecticut
LESLIE CURRY
Affiliation:
Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
EMILY CHERLIN
Affiliation:
Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, Connecticut
R. JOHNSON-HURZELER
Affiliation:
The Connecticut Hospice and John D. Thompson Institute for Training, Education, and Research, Inc., Branford, Connecticut
ELIZABETH BRADLEY
Affiliation:
Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, Connecticut

Abstract

Objective: Previous studies reveal that many terminally ill patients never receive hospice care. Among those who do receive hospice, many enroll very close to the time of death. Nationally, between 1992 and 1998, the median length of stay at hospice declined 27%, from 26 to 19 days. In our prior study of 206 patients diagnosed with terminal cancer and using hospice, we found that one-third enrolled with hospice within 1 week prior to death. Late hospice enrollment can have deleterious effects on patients and their family members. The aim of the present study was to characterize common experiences of patients and primary family caregivers as they transition to hospice, focusing on caregiver perceptions of factors that might contribute to delays in hospice enrollment.

Methods: We conducted in-depth interviews with a purposive sample of 12 caregivers selected from a population of primary family caregivers of patients with terminal cancer who enrolled with hospice in Connecticut between September 2000 and September 2001. Respondents represented different ages, genders, and kinship relationships with patients. Respondents were asked about the patient's care trajectory, how they first learned about hospice, and their experiences as they transitioned to hospice. NUD*IST software was used for qualitative data coding and analysis.

Results: Constant comparative analysis identified three themes common to the experience of transitioning to hospice: (1) caregivers' acceptance of the impending death, (2) challenges in negotiating the health care system across the continuum of care, and (3) changing patient–family dynamics.

Significance of results: Identification of these themes from the caregivers' perspective generates hypotheses about potential delays in hospice and may ultimately be useful in the design of interventions that are consistent with caregivers' needs.

Type
Research Article
Copyright
© 2004 Cambridge University Press

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