Learning Objective #1: Identify rates of notification of hospice eligibility in a university hospital for Pulmonary Disease, End-Stage Renal Disease, and Amyotrophic Lateral Sclerosis patients

Learning Objective #2: Identify two problems related to late admissions to hospice for patients and families

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Hospice provides comprehensive services for dying patients and their families. Patients are often not admitted to hospice early enough to utilize the needed services. It is hypothesized that patients are not notified about the eligibility for hospice services until late in their disease. Notification rates for terminally ill pulmonary disease (PD), end-stage renal disease (ESRD), and amyotrophic lateral sclerosis (ALS) patients were examined using hospice's criteria for admission. A descriptive study retrospectively reviewed 124 charts of inpatients with PD, ESRD, and ALS who may have been eligible for hospice. The tools used, which were reviewed for content validity by an expert, were the admission criteria for hospice based on the National Hospice and Palliative Care Organization (NHPCO) standards. All charts of PD patients requiring ventilator support and ALS patients were reviewed. Twenty percent of randomly chosen ESRD patients' charts were reviewed so that the sample size for each of the diagnosis was similar. The data was analyzed using non-parametric, descriptive statistics. Results showed that of the 124 charts reviewed, 9 patients were eligible for hospice (7.3%). Of the 9 eligible patients, only 5 (55%) were informed of hospice services. Of the 5 informed, 1 (20%) died before discharge. Of the 4 patients that were eligible and not informed, 2 (50%) died before discharge; 33% of eligible patients died before discharge. Hospice is important to terminally ill patients. If patients and their families are not notified or are notified late that they are eligible for hospice services, they cannot avail themselves of these services. Patients and families often seek information from nurses, who can assume a proactive role in end of life care and advocate for them with their primary care providers, facilitating referrals to hospice.

This study was funded with an internal grant from the College of Nursing.