Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence

Candy, Bridget; Holman, Amanda; Leurent, Baptiste; Davis, Sarah; Jones, Louise

doi:10.1016/j.ijnurstu.2010.08.003

Cited by 101 publications

(98 citation statements)

References 26 publications

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“…Based on these results, potential avenues for future interventions include (1) improving understanding of hospice philosophy and EOL care through communication, (2) tackling the challenges that patients and families face when transitioning to home hospice care, (3) identifying and reducing caregiver burden, and (4) improving symptom and crisis management.…”

Section: Resultsmentioning

confidence: 99%

“…In the United States, hospice has been shown to improve quality of care and satisfaction among patients and caregivers. [1][2][3] While a majority of hospice patients are treated successfully at home, there are situations when home hospice may be insufficient and patients opt for hospitalization. 4 In these situations hospice organizations can provide continuous home care (CHC) or general inpatient (GIP) care as an alternative to regular home hospice care.…”

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Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives

PhongtankuelVeerawat

ScherbanBenjamin

ReidManney

et al. 2016

Journal of Palliative Medicine

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Background: Hospice provides an opportunity for patients to receive care at home at the end of life (EOL); however, approximately 25% of patients who disenroll from hospice are hospitalized. Hospitalization can lead to poor care transitions and result in unwarranted care and adverse patient outcomes. Research examining reasons for hospitalization in this patient population is limited. Objective: The objective was to understand the reasons for hospitalization among home hospice patients through the perspectives of hospice interdisciplinary team (IDT) members. Methods: This was a qualitative study using a grounded theory approach. Seven semistructured focus group were conducted to solicit reasons for hospitalization among home hospice patients. Participants consisted of 73 home hospice IDT members from a not-for-profit hospice agency in New York City. Focus group recordings were transcribed and analyzed using content analysis. Results: Eight major themes were identified: (1) not fully understanding hospice, (2) lack of clarity about disease prognosis, (3) desire to continue receiving care from nonhospice physicians and hospital, (4) caregiver burden, (5) distressing/difficult-to-manage signs and symptoms, (6) caregivers' reluctance to administer morphine, (7) 911's faster response time compared to hospice, and (8) families' difficulty accepting patients' mortality. Conclusions: Reasons for hospitalization in home hospice patients are multifactorial and complex. Our study highlights barriers and challenges that patients, families, physicians, and hospices face around home hospice care and hospitalization. More research is needed to elucidate these issues and develop viable strategies to address them.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives

PhongtankuelVeerawat

ScherbanBenjamin

ReidManney

et al. 2016

Journal of Palliative Medicine

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“…Characteristics of included reviews 15 16 ; meta synthesis 26 and narrative reviews 7,17,18,19,20,21,22,23,24,25,27,30 . 14 Our approach to reporting on the models across settings is pragmatic due to the lack of detailed 15 description of the models in the included publications.…”

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confidence: 99%

“…The 13 benefits include an increased likelihood of dying at home, as identified in two meta-analyses 14,16 . 19 Four reviews 21,22,23,24 report on specialised or specialist palliative care, including models of hospice care.…”

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confidence: 99%

“…Three of these reviews report on the costs of specialist or specialised palliative care 21,22,24 . Although 1 limited cost data exist, reviews concur that the models are associated with cost savings, usually due to a 2 reduction in general health care use 24, , emergency care use 24 , hospital costs (although this review also 3 reports that home and hospice care costs increased when patients were referred to a palliative care 4 programme) 22 and inpatient stays 21 .…”

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What do we know about different models of providing palliative care? Findings from a systematic review of reviews

et al. 2017

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Article:Brereton, L., Clark, J., Ingleton, C. orcid.org/0000-0001-5489-1089 et al. (4 more authors) (2017) What do we know about different models of providing palliative care? Findings from a systematic review of reviews. Palliative Medicine. ISSN 0269-2163 https://doi.org/10.1177/0269216317701890 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Review of models of palliative care1 What is already known about the topic? 1  Globally, as demand for palliative care is increasing amongst those with life-limiting illnesses, 2 there has been a rapid growth in specialist and generalist palliative care service provision with a 3 range of different of models of palliative care service provision being developed and 4 implemented internationally. 5 The published evidence has been synthesised in a number of reviews which have attempted to 6 identify the effectiveness and cost effectiveness of different models of palliative care. 7 There is no comprehensive overview of the current evidence base to support decision-making 8 based on the advantages and disadvantages of different models of palliative care or to identify 9 any gaps in the evidence base where more primary research is needed. 10What this paper adds? 11 The outcomes measured vary considerably, making meta-analysis impossible. None-the-less, 12 the available evidence indicates that irrespective of setting or patient characteristics, models of 13 palliative care appear to show benefits for patients and their carers, with no evidence for 14 negative effects. Some models of palliative care may reduce total healthcare costs.

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Content Analysis of Negative Online Reviews of Hospice Agencies in the United States

et al. 2020

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IMPORTANCE As online reviews of health care become increasingly integral to patient decisionmaking, understanding their content can help health care practices identify and address patient concerns.OBJECTIVE To identify the most frequently cited complaints in negative (ie, 1-star) online reviews of hospice agencies across the United States. DESIGN, SETTING, AND PARTICIPANTSThis qualitative study conducted a thematic analysis of online reviews of US hospice agencies posted between August 2011 and July 2019. The sample was selected from a Hospice Analytics database. For each state, 1 for-profit (n = 50) and 1 nonprofit (n = 50) hospice agency were randomly selected from the category of extra-large hospice agencies (ie, serving >200 patients/d) in the database. Data analysis was conducted from MAIN OUTCOMES AND MEASURES Reviews were analyzed to identify the most prevalent concerns expressed by reviewers. RESULTSOf 100 hospice agencies in the study sample, 67 (67.0%) had 1-star reviews; 33 (49.3%) were for-profit facilities and 34 (50.7%) were nonprofit facilities. Of 137 unique reviews, 68 (49.6%) were for for-profit facilities and 69 (50.4%) were for nonprofit facilities. A total of 5 themes emerged during the coding and analytic process, as follows: discordant expectations, suboptimal communication, quality of care, misperceptions about the role of hospice, and the meaning of a good death. The first 3 themes were categorized as actionable criticisms, which are variables hospice organizations could change. The remaining 2 themes were categorized as unactionable criticisms, which are factors that would require larger systematic changes to address. For both for-profit and nonprofit hospice agencies, quality of care was the most frequently commented-on theme (117 of 212 comments [55.2%]). For-profit hospice agencies received more communication-related comments overall (34 of 130 [26.2%] vs 9 of 82 [11.0%]), while nonprofit hospice agencies received more comments about the role of hospice (23 of 33 [69.7%] vs 19 of 31 [61.3%]) and the quality of death (16 [48.5%] vs 12 [38.7%]). CONCLUSIONS AND RELEVANCE Regarding actionable criticisms, hospice agencies could examinetheir current practices, given that reviewers described these issues as negatively affecting the already difficult experience of losing a loved one. The findings indicated that patients and their families, friends, and caregivers require in-depth instruction and guidance on what they can expect from hospice staff, hospice services, and the dying process. Several criticisms identified in this study (continued) Key PointsQuestion What are the most common criticisms found in negative (ie, 1-star) online reviews of hospice agencies? Findings In this qualitative study of 137 unique online reviews of 67 hospice agencies, 2 domains of criticisms emerged: actionable criticisms, which are variables hospice organizations can change and include the themes of expectations, communication, and quality of care, and unactionable criticisms, which are variables that requ...

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Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence

Cited by 101 publications

References 26 publications

Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives

Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives

What do we know about different models of providing palliative care? Findings from a systematic review of reviews

Content Analysis of Negative Online Reviews of Hospice Agencies in the United States

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