Measuring Attitudes About End-of-Life Care: Evaluation of a Modified Version of the Hospice Philosophy Scale

2018 ◽  
Vol 39 (8) ◽  
pp. 828-833
Author(s):  
Daniel J. Van Dussen ◽  
John Cagle ◽  
Amy J. Plant ◽  
Seokho Hong ◽  
Krystal L. Culler ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Convergent Validity ◽  
Hospice Care ◽  
Adult Population ◽  
Life Care ◽  
Cross Sectional ◽  
Validation Data ◽  
End Of Life Issues ◽  
Hospice Use

The Hospice Philosophy Scale (HPS) is the only scaled instrument that measures health professionals’ attitudes about end-of-life care consistent with the hospice philosophy. This study tested the properties of a modified version of the HPS to provide preliminary validation data on internal consistency, convergent validity, and factorability in a broad population of adults. A cross-sectional telephone survey designed to assess the general population’s attitudes regarding hospice use was administered. exploratory factor analysis elicited an eight-item instrument (HPS-8). The HPS-8 produced a Cronbach’s alpha of .73 and demonstrated sufficient convergent validity, including positive associations with a scale measuring the importance of relevant end-of-life issues ( r = .41, p < .001), a personal preference for hospice (ρ = .36, p < .001), and, among those who had experienced hospice care, satisfaction with hospice care (ρ = .28, p < .01). Our evidence suggests the HPS-8 is a reliable and valid instrument for use with a general adult population.

Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions

2020 ◽  
Vol 16 (12) ◽  
pp. 803-809
Author(s):  
Mihir N. Patel ◽  
Jonathan M. Nicolla ◽  
Fred A.P. Friedman ◽  
Michala R. Ritz ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Hospice Care ◽  
Rapid Development ◽  
Spiritual Needs ◽  
Life Care ◽  
General Acceptance ◽  
Patients With Cancer ◽  
Hospice Use

Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients’ biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.

scholarly journals RACIAL DISPARITIES IN HOSPICE USE AT THE END OF LIFE: FINDINGS FROM THE REGARDS STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S436-S436
Author(s):  
Katherine Ornstein ◽  
Orla C Sheehan ◽  
Jin Huang ◽  
J David Rhodes ◽  
David L Roth
Keyword(s):  
Racial Disparities ◽  
End Of Life ◽  
Racial Differences ◽  
Cause Of Death ◽  
End Of Life Care ◽  
Hospice Care ◽  
Life Care ◽  
Stroke Incidence ◽  
Regards Study ◽  
Hospice Use

Abstract Hospice supports patients and families through interdisciplinary care focused on symptom management and maximization of quality of life. Although hospice care confers well-documented benefits, it remains underutilized: many patients do not use it at all or enter care too late to receive any benefit. While racial disparities in hospice use have been documented, hospice utilization among non-white decedents remains understudied, particularly among those with non-cancer diagnoses. Therefore, we used the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based investigation of stroke incidence with oversampling of Blacks and cause of death adjudication by expert panel review, linked to Medicare claims data to examine racial disparities in end-of-life care. We identified 1221 participants who died between 2013-2015 due to natural causes excluding sudden death. More than half (52.8%) used hospice during the last 6 months of life (median =15 days), with use among cancer decedents over 70%. Overall, Blacks were significantly less likely to use hospice (OR=0.570) compared to Whites in adjusted analyses. Among hospice users, Blacks did not significantly differ from Whites in length of stay. In analyses stratified by cause of death (dementia, cancer, CVD and other), Blacks were significantly less likely than Whites to use hospice for all causes of death other than dementia. Despite tremendous growth of hospice in recent decades, our findings suggest that this effective service remains highly underutilized among Blacks dying from cancer, CVD and other serious illnesses, suggesting a need for targeted intervention to eliminate disparities in quality end-of-life care.

scholarly journals Factors affecting attitudes towards end-of-life care among medical students in China: a cross-sectional study

2021 ◽  
Vol 21 ◽  
pp. 323-331
Author(s):  
Rui Jia ◽  
Min Chen ◽  
Kang Wang ◽  
Xinrui Zhou ◽  
Xin Wang ◽  
...  
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Care Service ◽  
Human Life ◽  
Palliative Care Service ◽  
Special Kind ◽  
Life Care ◽  
Cross Sectional

End-of-life care is regarded as a special kind of palliative care service. At present, people in our country are still relatively unfamiliar with end-of-life care. As a future medical worker whose work is about human life, health, disease, and death, their attitudes towards end-of-life of medical students affects all aspects of their medical behavior. The purpose of our research is to identify and describe factors associated with medical students' attitudes towards end-of-life care. Ninety-one medical students chosen by stratified random sampling at School of Medicine, Xi'an Jiaotong University completed several questionnaires focused on attitudes towards end-of-life care. The scores of end-of-life care attitudes of nursing major (133.3±9.6) is higher than clinical; grade 1 (132.3±9.8) is higher than grade 2, 3 or 4; "Calm and open atmosphere" in discussing the death situation at home (132.4±9.8) was higher than "never discussed death" and other situations; who had never suffered from serious illness (131.8±9.5) was higher than that of those who had suffered. The differences were statistically significant (P<0.05). The correlations coefficient between meaning of life (r=0.47), between the death fear dimension (r=-0.35), death escape dimension (r=-0.27), natural acceptance dimension (r=0.34), approach acceptance dimension (r=-0.21), escape acceptance dimension (r=-0.24), adolescent life events (r=0.19) and end-of-life care attitudes were significant correlation (P<0.01). After controlling of demographic sociological variables, psychological factors have made new contributions to hospice care attitudes, and the explained variance has increased by 32.0%. Medical students with different characteristics have significant differences in end-of-life care attitudes, which suggesting the lack of education in end-of-life care in our country, and the failure of education to enable medical students of different backgrounds to establish a scientific, rational and humanistic care attitude.

Qualities of Culturally and Religiously Sensitive Practice: A Cross-Sectional Study

2021 ◽  
pp. 082585972110507
Author(s):  
Panagiotis Pentaris ◽  
Panayiota Christodoulou
Keyword(s):  
Lived Experience ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Cross Sectional Study ◽  
Cultural Humility ◽  
Life Care ◽  
Sectional Study ◽  
Cancer Society ◽  
Cross Sectional

Background: Culture and religion influence lived experience and particularly dying and grieving. Research has largely focused on exploring culturally and religiously sensitive practices, but not necessarily in palliative and hospice care or across nations. Acquired knowledge from the more advanced end-of-life care systems (eg the UK) tends to be generalized to other contexts where its cultural appropriation is not tested. Aim: This study explored the different qualities, among hospice and palliative professionals in Cyprus, describing cultural competence, cultural humility, and religious literacy. Design: A cross-sectional study of 41 palliative and hospice professionals in Cyprus, with the use of a 5-point Likert style questionnaire ( a = 0.898). Setting: The study took place in Cyprus and participants were recruited from across palliative and hospice care organizations, including the only hospice in Cyprus, Cyprus Association of Cancer Patients and Friends (PASYKAF), and the Cyprus Anti-Cancer Society (CACS). Results: This study found that there are four main qualities that lead to effective culturally and religiously sensitive practice—informed decision-making, respect, adaptability, and nonjudgmental practice. Conclusions: Future education and training of professionals can consider these findings to appropriate approaches in practice that fit the Cypriot end-of-life care context more effectively.

scholarly journals Analysis of The Status Quo and Influencing Factors of The Death Coping Self-Efficacy of Clinical Nurses: A Cross-Sectional Study

2021 ◽  
Author(s):  
Xi Lin ◽  
Xiaoqin Li ◽  
Qin Liu ◽  
Weilan Xiang
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Influencing Factors ◽  
Self Efficacy ◽  
End Of Life Care ◽  
Hospice Care ◽  
Life Care ◽  
Cross Sectional ◽  
Clinical Nurses

Abstract Background Nurses are the main caregivers to dying patients. It is inevitable to face or deal with death-related events. The ability of death-coping self-efficacy (DCS) is very important, which can reduce the risk of nursing staff, suffering from adverse emotional distress and help them to better participate in the end-of-life care of the patients and improve the quality of care. Methods Using the convenient sampling method, a total of 572 nurses were included in this study from a tertiary hospital in Hangzhou, China. The situation and influencing factors of the clinical nurses' DCS were explored using the General Information Questionnaires and DCSS. (DCS scale). Results The scores of each parameter, ranging from low to high, were as following: grief coping, death preparation, and hospice care. The influencing factors of nurses' DCS included the hospice care education courses received in the last year, the experience of accompanying the family members of the deceased, and the attitude towards death. Conclusions The overall self-efficacy of nurses in palliative care was at a medium level and the sense of their self-efficacy in coping with the grief and preparation for death needed to be strengthened. The nursing managers should pay attention to the education and training of palliative care, which will strengthen the psychological and spiritual caring abilities of the nurses for the patients and their families, increase their experience of end-of-life care, improve their cognition of palliative care, and help them in establishing a correct view of death, thereby leading to improve the quality of palliative care.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Serious Mental Illness and Hospice Care

2021 ◽  
pp. 082585972110220
Author(s):  
Gwen Levitt
Keyword(s):  
Mental Health ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychiatric Illness ◽  
Hospice Care ◽  
Treatment Options ◽  
Life Care ◽  
Case Review ◽  
Health Community ◽  
End Stage

There are a small number of articles in the literature discussing palliative and end-of-life care in the SMI population. Most tackle the questions relating to competency to refuse care in end-stage anorexia or terminal medical conditions. This is a case review of a 55 year old patient with a complex psychiatric and medical history, who despite extensive treatment and long hospitalizations has failed to regain any ability to care for her basic needs. She has exhausted all available treatment options and her prognosis is extremely poor. The mental health community is resistant to discussing and/ or confronting the fact that such a patient faces with the need for end-of-life care directly related to chronic psychiatric illness.

scholarly journals Exploration of the Factor Structure of the Burden Experienced by Individuals Providing End-of-Life Care at Home

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Chizuru Nagata ◽  
Hironori Yada ◽  
Junko Inagaki
Keyword(s):  
Factor Analysis ◽  
End Of Life ◽  
Factor Structure ◽  
Caregiver Burden ◽  
End Of Life Care ◽  
Convergent Validity ◽  
Life Care ◽  
Term Care ◽  
Care At Home ◽  
At Home

In Japan, the number of elderly people who require long-term care is increasing as a result of the country’s aging population. Consequently, the burden experienced by caregivers who provide end-of-life care at home has become a social problem. This study aimed to confirm the factor structure of such caregiver burden by analyzing the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI). The J-ZBI was administered to 389 caregivers providing end-of-life care, and 247 answers were analyzed, with exploratory factor analysis performed on the results. Consequently, a four-factor structure emerged (sacrificing life, personal strain, severe anxiety, and captivity); these four factors, constituting 15 items, were cumulatively named “J-ZBI_15.” In regard to reliability, Cronbach’sαcoefficient for each factor was high; in terms of validity, a confirmatory factor analysis was conducted to examine the four-factor structure, and the goodness of model fit was determined to be satisfactory. Further, the convergent validity was also high. The care burden experienced by those providing end-of-life care at home differs from the burden of caregivers of individuals with other diseases, such as Alzheimer’s. For assessing the burden felt by this population, the 15-item four-factor ZBI model is more appropriate than the single-factor 22-item ZBI, and we also determined that J-ZBI_8 is unsuitable for this task. Thus, measurement of family caregivers’ burden in regard to providing end-of-life care at home should be performed using the 15-item four-factor J-ZBI model.

scholarly journals Caregiver evaluation of the quality of end-of-life care (CEQUEL) scale: The caregiver’s perception of patient care near death.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6573-6573
Author(s):  
Philip C Higgins ◽  
Holly Gwen Prigerson
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Convergent Validity ◽  
Risk Indicator ◽  
Life Care ◽  
Trauma Symptoms ◽  
Prospective Longitudinal Study ◽  
Eol Care ◽  
Prospective Longitudinal

6573 Background: End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. None include caregiver perception of patient suffering and prolongation of death. We developed and validated the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a more comprehensive measure of caregiver-perceived quality of EOL care. Methods: Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). Caregivers were assessed before and after patient deaths. CEQUEL’s factor structure was examined; reliability was evaluated using Cronbach’s α, and convergent validity by the strength of associations between CEQUEL scores and key EOL outcomes. Results: Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The 13-item CEQUEL and its subscales showed moderate to acceptable Cronbach’s α (range: 0.52-0.78). 53% of caregivers reported patients suffering more than expected. Higher CEQUEL scores were positively associated with therapeutic alliance (r=.13; p≤.05) and hospice enrollment (z=-2.09; p≤.05), and negatively associated with bereaved caregiver regret (r=-.36, p≤.001) and trauma symptoms (z=-2.06; p≤.05). Conclusions: CEQUEL is a brief, valid measure of quality of EOL care from the caregiver’s perspective. It is the first scale to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment.

scholarly journals Preferences for Advance Directives in Korea

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
So-Sun Kim ◽  
Won-Hee Lee ◽  
JooYoung Cheon ◽  
Jung-Eun Lee ◽  
KiSun Yeo ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Healthcare Providers ◽  
Tube Feeding ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Korean People ◽  
End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

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