The Experience of Transition From Hospital to Home Hospice

Dose, Ann Marie; Rhudy, Lori M.; Holland, Diane E.; Olson, Marianne E.

doi:10.1097/njh.0b013e318227f8f2

Cited by 11 publications

(13 citation statements)

References 30 publications

(43 reference statements)

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“…The EOL care setting transition issues identified in Ontario are of considerable concern, but willingness there to address these issues was also evident. These issues are not confined to Ontario (Aaltonen et al, 2014;Abarshi et al, 2010;Darlington et al, 2015;Dose et al, 2011;Gozalo et al, 2011;Hanratty et al, 2012;Hatcher et al, 2014;Larkin et al, 2007;Lawson et al, 2006Lawson et al, , 2008Morrison et al, 2016;Reinke et al, 2008;Wilson et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Six articles reported qualitative research investigations with different foci. Among these, Dose, Rhudy, Holland, and Olson (2011) found American palliative patients who moved from hospital to home hospice and their families felt disrupted "because of lack of clarity regarding hospice, their scramble to get ready, and a sense of open house once they arrived home" (p. 394). Larkin et al's study in six European countries identified issues: "transition is a confusing time of mixed messages, poor communication, and uncertainty" (p. 69).…”

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confidence: 99%

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Moving from place to place in the last year of life: A qualitative study identifying care setting transition issues and solutions in O ntario

Wilson

Birch

2017

Health Soc Care Community

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Moving from one care setting to another is common as death nears. Many concerns exist over these end-of-life (EOL) care setting transitions, including low-quality moves as mistakes and other mishaps can occur. Delayed or denied moves are also problematic, such as a move out of hospital for dying inpatients who want to spend their last hours or days at home. The aim of the study was to identify current issues or problems with care setting transitions during the last year of life as well as potential or actual solutions for these problems. A grounded theory analysis approach was used based on interviews with 38 key informants who represent a wide range of healthcare providers, healthcare managers, government representatives, lawyers, healthcare recipients and their family/friends across Ontario in 2016. Three interrelated themes were revealed: (a) communication complexities, (b) care planning and coordination gaps and (c) health system reform needs. Six solutions were highlighted, with these designed to prevent care setting transition issues and monitor care setting transitions for continued improvements.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Moving from place to place in the last year of life: A qualitative study identifying care setting transition issues and solutions in O ntario

Wilson

Birch

2017

Health Soc Care Community

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“…They were continually being tested with unexpected crises, change and loss to roles, relationships, routines and their ability to engage in valued occupations. Living with uncertainty is a commonly described experience in palliative care literature, particularly in the context of coping with care at home and inevitable functional decline (Benzar et al, 2011;Dose et al, 2011;Park Lala and Kinsella, 2011). It can be assumed that the participants' difficulty in knowing who to seek help from for specific issues at home would have definitely contributed to this uncertain context they were trying to adapt to.…”

Section: Discussionmentioning

confidence: 99%

Patients’ and caregivers’ perceptions of occupational therapy and adapting to discharge home from an inpatient palliative care setting

Marston

Agar

Brown

2015

British Journal of Occupational Therapy

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Introduction: There is limited research into the role of occupational therapy in discharge planning in palliative care. This study aimed to explore patients' and caregivers' perceptions of occupational therapy in the context of discharge home from an inpatient palliative care setting. Method: Semi-structured interviews were conducted with patients and caregivers following discharge home from inpatient palliative care. Participants were selected using purposive sampling and data was thematically analysed. Results: Five caregivers and three patients were interviewed. Three main themes emerged: (1) shared roles in discharge planning;(2) perceived benefits of occupational therapy; and (3) adapting to discharge home. Patients and caregivers viewed occupational therapy as the practical help needed to achieve discharge. They had difficulty differentiating between professional roles and perceived the discharge process as a shared responsibility between themselves and the clinicians. Adapting to discharge home involved coping with the uncertain and unexpected, where limited understanding of professional roles meant participants did not know who to seek assistance from. Conclusion: Occupational therapy was viewed as the practical help needed for discharge home from a palliative care setting.Clinicians need to take primary responsibility for understanding each other's roles and providing information on who can assist after discharge.

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“…In another study, patients and families reported that there was a disruption of services during the transition from hospital care to hospice home care, including the demands of physical care, medication concerns, and lack of clarity regarding the hospice role. 6 Jiang et al 1 examined the timing of after-hours telephone triage services for hospice and palliative services and found that the most frequently requested services included assistance with symptom control, to report death, and to request a home visit. The findings of this study can provide a better understanding of the timing and reasons for after-hours calls and can assist in providing a basis for designing interventions that have the potential to improve care.…”

Section: Literature Reviewmentioning

confidence: 99%

A Quality Improvement Assessment of Emergency Department Visits by Hospice Home Care Patients

Batchelor¹

2015

Journal of Hospice & Palliative Nursing

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Estimates suggest that greater than 25% of Medicare resources are used in the last 6 months of life. One significant source of cost is related to emergency care delivered to hospice patients for symptom management near the end of life. As the first phase of a quality improvement initiative, the purpose of this project was to determine reasons for and prevalence of hospice home care patients who access emergency departments for symptom management near the end of life and to explore factors that may influence patients' decisions to do so. A review of 1 hospice agency's annual report data for 2011 indicated that 147 hospice patients sought emergency care many for symptoms that occur near the end of life, whereas a significant number of visits were attributed to falls and sequelae. Results of an investigator-developed survey distributed to home care nurses indicated that although written information was provided to patients and caregivers regarding what to do when changes in condition occurred, family/ caregivers became anxious and sought emergency care. Revision of educational materials and development of strategies to address the needs of this population should inform future projects. KEY WORDSemergency care, hospice, symptom management A ccording to the National Hospice and Palliative Care Organization (NHPCO), hospice is a model of care that provides quality compassionate care for patients and their family and is expressly tailored to the individual's needs and wishes of those facing a lifelimiting illness. 1 The purpose of the hospice program is to provide patients in the terminal stages of disease with an improved quality of life for their remaining time and that strategies to control symptoms be instituted in their environment of choice. According to the literature, given a choice, terminally ill patients prefer to die at home. 1 The NHPCO reports that 66.7% of hospice patients are cared for in the place that the patient calls home: private residence, residential facility, or nursing home. 2 As death approaches, symptoms may escalate, causing increased suffering. When patients experience an increase in symptoms, they often seek care at the emergency department (ED), which can be disruptive and exhausting. 3 This can also be distressing to the caregiver and the health care professionals responsible for their care. 3 Seeking treatment in an acute care facility while enrolled in a hospice program can also have philosophical and financial repercussions for all involved. The hospice philosophy focuses on comfort care and allows the disease to take its natural course, whereas care in an ED is usually focused on more aggressive treatment. Although findings indicate that hospice patients access the ED for symptom management, the prevalence of ED visits among patients enrolled in this hospice program and the possible factors that may contribute to ED visits in this population is not known. Objective of the ProjectThe initiation of this quality improvement (QI) project was based on this author's observations of hospice ...

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The Experience of Transition From Hospital to Home Hospice

Cited by 11 publications

References 30 publications

Moving from place to place in the last year of life: A qualitative study identifying care setting transition issues and solutions in O ntario

Moving from place to place in the last year of life: A qualitative study identifying care setting transition issues and solutions in O ntario

Patients’ and caregivers’ perceptions of occupational therapy and adapting to discharge home from an inpatient palliative care setting

A Quality Improvement Assessment of Emergency Department Visits by Hospice Home Care Patients

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