Hospice Readiness in a Population of Palliative Care Patients

Monday, July 11, 2011

Janet Houser, PhD, RN
Rueckert Hartman College for Health Profession, Regis University, Denver, CO
Julie MacCluskey, BSN, MSN
Pathways Palliative Care, The Denver Hospice, Denver, CO

Learning Objective 1: The learner will be able to differentiate hospice eligibility from hospice readiness

Learning Objective 2: The learner will be able to determine the reasons that palliative care patients and their families are not ready for hospice when they become eligible

Purpose: The aim of this evaluation study was to describe the reasons that palliative care patients eligible for hospice were unwilling to consider it.

Methods: Providers in an urban palliative care service recorded hospice eligibility in three categories:  Not hospice eligible; eligible and ready for hospice; and eligible but not ready for hospice. The providers also recorded, for those who were judged eligible but not ready, “By whose assessment?” and the reason for lack of readiness.  Data were collected from 755 patients. Descriptive statistics were applied to determine elements of readiness.

Results: 51.9% of the palliative care patients in this sample were ineligible for hospice.  Only 6.4% were ready for hospice at the time they become eligible; the remaining 42% were eligible but not ready. Most commonly, it was the family’s perception that the patient was not ready for hospice.  The most common reasons for resisting hospice admission were related to hope – the patient and their family wanted to exhaust all treatments prior to entering hospice, because hospice was viewed as “giving up.” A strong reason for resisting hospice admission was the desire – often on recommendation of the physician – that the patient would be more comfortable if they continued palliative treatments, most commonly palliative chemotherapy, radiation therapy, and blood transfusions. A small proportion of patients resisted hospice out of denial of their illness; 10% want to believe that their illness is not terminal. 4% of the time the attending physician was not sure if the patient’s condition was terminal.

 Conclusion: Less than half of those who are in palliative care are eligible for hospice. Patients and their families often have legitimate reasons for resisting the move from palliative care to hospice. Understanding these reasons can help the nurse assist these patients in determining end of life goals.