Referral and timing of referral to hospice care in nursing homes: the significant role of staff members

The Gerontologist
Lisa C WelchAman Nanda

Abstract

Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors of nursing regarding facility referral practices and conducted interviews with 34 NH nurses, 30 NH aides, and 17 hospice nurses knowledgeable about the factors that led to the hospice status of 32 NH decedents. Selected decedents varied by diagnosis and hospice status (received hospice for >7 days, <or=7 days, or not at all). We audiotaped, transcribed, and coded interviews for themes. NH staff members' recognition of terminal decline, beliefs about hospice, and initiative significantly influenced hospice referral and timing of referral. Staff members' recognition of familiar signs of decline facilitated hospice referral; in contrast, a perception that death was unexpected impeded referral, and a perception of uncertain prognosis delayed referral. Staff members' beliefs that hospice does not add value to NH care or is for crises only impeded referral, and a belief that hospice is only for the "very end" delayed re...Continue Reading

References

Jun 12, 1998·JAMA : the Journal of the American Medical Association·J C WeeksR S Phillips
Sep 1, 2000·Journal of the American Geriatrics Society·W M Baer, L C Hanson
Nov 14, 2000·JAMA : the Journal of the American Medical Association·M J SilveiraC Feudtner
Dec 15, 2000·Archives of Family Medicine·L L EmanuelF D Ferris
Jul 13, 2001·The American Journal of Medicine·S C MillerV Mor
Apr 12, 2002·Journal of the American Geriatrics Society·Susan C MillerKate Lapane
Jul 12, 2002·Journal of the American Geriatrics Society·Jiska Cohen-Mansfield, Steven Lipson
Oct 31, 2002·Palliative Medicine·S C Miller, V Mor
Mar 8, 2003·Archives of Internal Medicine·Mark P PfeiferLynell Chamberlain
Sep 12, 2003·Journal of Pain and Symptom Management·Susan C MillerJoan Teno
Jan 8, 2004·JAMA : the Journal of the American Medical Association·Joan M TenoVincent Mor
Dec 14, 2004·Journal of Pain and Symptom Management·Susan C Miller, Vincent Mor
Jan 28, 2005·Journal of the American Geriatrics Society·Susan L MitchellVincent Mor
Jul 15, 2005·JAMA : the Journal of the American Medical Association·David CasarettDavid A Asch
Nov 29, 2005·Journal of Pain and Symptom Management·Erica R SchockettBrad Stuart
Feb 3, 2006·The Gerontologist·Vicki A FreedmanJennifer C Cornman
Mar 23, 2006·Journal of the American Geriatrics Society·Jean C MunnC Madeline Mitchell
May 11, 2006·Health Affairs·Beth HanShirley S Travis
Mar 17, 2007·Health Services Research·Pedro L Gozalo, Susan C Miller

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Citations

Jul 10, 2009·Journal of Palliative Medicine·Deborah P Waldrop, Abbie M Kirkendall
Aug 25, 2009·Journal of Palliative Medicine·Caprice A KnappElizabeth A Shenkman
Apr 28, 2010·Journal of Palliative Medicine·Renee R ShieldLisa C Welch
Jan 11, 2012·The Gerontologist·Helena Temkin-GreenerDana B Mukamel
Dec 7, 2010·American Journal of Alzheimer's Disease and Other Dementias·Susan C MillerSusan L Mitchell
Aug 2, 2011·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Ebun A AbarshiBregje D Onwuteaka-Philipsen
Mar 13, 2012·Critical Care Nursing Clinics of North America·Deborah Borowske
Jul 8, 2015·Journal of Pain and Symptom Management·Kathleen T UnroeSusan C Miller
Jul 22, 2010·Journal of the American Geriatrics Society·Susan C MillerVincent Mor
Dec 2, 2010·Journal of Clinical Nursing·Chu-Yun Lu, Meg Johantgen
Feb 24, 2015·Journal of Pain and Symptom Management·Isabelle van RiesenbeckOrah R Burack
Sep 9, 2009·Journal of Pain and Symptom Management·David G Stevenson, Jeffrey S Bramson
Dec 3, 2014·Journal of the American Medical Directors Association·Daniel Swagerty
Sep 23, 2014·Journal of the American Medical Directors Association·Kathleen T UnroeSusan C Miller
Jul 14, 2016·Geriatric Nursing·Johannes BükkiPiret Paal
Aug 17, 2016·Journal of Palliative Medicine·Helena Temkin-GreenerDana B Mukamel
Oct 15, 2011·The American Journal of Hospice & Palliative Care·Jean Correll Munn
Apr 16, 2009·The American Journal of Hospice & Palliative Care·Helaine E ResnickSusan E Hickman
May 29, 2012·Journal of the Chinese Medical Association : JCMA·Shih-Chao KangShinn-Jang Hwang
Apr 7, 2017·Journal of Applied Gerontology : the Official Journal of the Southern Gerontological Society·Lusine NahapetyanXiao Song

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