Exploring Barriers Among Primary Care Providers in Referring Patients to Hospice

Torres, Lisa; Lindstrom, Kathryn B.; Hannah, Liane; Webb, Fern J.

doi:10.1097/njh.0000000000000233

Cited by 7 publications

(1 citation statement)

References 21 publications

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“…While most providers receive some education about this topic, they often lack time and insufficient resources to adequately address the unique needs of this population, which further reduces the likelihood of referring patients to HC. 49 To promote effective patient-provider interactions involving partnership-building and optimal patient outcomes, providers must have training on approaching sensitive and complex conversations with vulnerable populations. 50 Future research could address ways to support effective patient-provider communication, in unreserved rural settings to promote HC to patients and their families.…”

Section: Discussionmentioning

confidence: 99%

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US–Mexico border region—a qualitative study

Fuentes

Singh-Carlson

et al. 2020

BMJ Open

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ObjectivesHospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US–Mexico border region.DesignThis qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis.SettingThe HC programme was situated at a local home health agency, located in rural Southern California, USA.ParticipantsTwenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study.ResultsConversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient’s known EOL wishes; (2) FCG-physician EOL communication; (3) the patient’s deteriorating health and (4) home as the place for death.ConclusionsHC patients’ FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient’s EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients’ medical status along with information about HC.

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Section: Discussionmentioning

confidence: 99%

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US–Mexico border region—a qualitative study

Fuentes

Singh-Carlson

et al. 2020

BMJ Open

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Social and organizational practices that influence hospice utilization in nursing homes

Rodriquez

Boerner

2018

Journal of Aging Studies

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Patient Rights at the End of Life

Smith

Torres

Burton

2020

Professional Case Management

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Purpose/Objectives: The end-of-life needs and desires of patients, whether it is related to a terminal illness or age-related end-of-life physiological function, can vary from patient to patient. Each dying patient's case should be approached in an individual and patient-centered fashion while supporting the dying patient's desired preferences related to end–of-life treatment. This serves to recognize the dying patient's individual rights related to self-determination of preserving his or her dignity during the end-of-life process. As the U.S. population continues to age at the fastest pace in history, it is vital for end-of-life patients and their family members, health care providers, and lawmakers to consider how health policy can drive legislation that supports the dying patient's right to express his or her dignity and own end-of-life desires related to aid-in-dying by allowing health care providers to legally provide physician-assisted health (PAD) and death with dignity (DD) the end-of-life care dying patients prefer. Primary Practice Setting(s): Palliative, hospice, and long-term care. Findings/Conclusions: When state laws do not support a terminally ill person's ability to make his or her own end-of-life decisions based on his or her own preferences and desires related to PAD and dignity in dying, there can be moral conflictions with the existing ethical principles that can contribute to additional distress and anxiety in the terminally ill patient. Not allowing the terminally ill patient the legal right to choose his or her preferences and desires at the end of life goes against the freedom of the patient to choose. The aging population is growing quickly, and people are living longer, which means the frail elderly in their final stages of death due to multisystem organ failure might also desire to have the option of PAD that supports dignity in dying. Implications for Case Management Practice: Case managers are an instrumental and integral part of the end-of-life care team. They are held to the same standard of practice as clinical care providers when it comes to promoting the biomedical ethical points autonomy, beneficence, nonmaleficence, justice, and fidelity. Following these ethical principles is critical for case managers to consider when supporting the desires and preferences of terminally ill patients. Case managers should be involved in all the patient-centered decision making for a terminally ill patient's desire for DD and PAD. It is critical for case managers to follow their organization's defined code of professional conduct as well their specific professional organization and professional certifying body's defined code of ethics and conduct despite their personal convictions.

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Exploring Barriers Among Primary Care Providers in Referring Patients to Hospice

Cited by 7 publications

References 21 publications

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US–Mexico border region—a qualitative study

Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US–Mexico border region—a qualitative study

Social and organizational practices that influence hospice utilization in nursing homes

Patient Rights at the End of Life

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