The Hospice Decision: Psychosocial Facilitators and Barriers

Abstract

This study examined the social and contextual process of discussion and decision making around the use of the hospice in order to clarify the facilitative and obstructive aspects to hospice patient entry. Four participants groups of physicians, hospice and home health care patient family survivors, and hospice and home health care staff, completed four complementary mail surveys of their discussions and decision process for hospice care. Non-parametric analysis of the data reaffirmed the central and key role of the physician as the expected initiator and gatekeeper of the hospice discussion and decision-making process. Physicians were found generally aware of hospice and to have discussed hospice with their patients, though that awareness and the frequency of hospice patient discussions varied by the type of medical practice. Patient family survivors were unaware of hospice prior to the terminal illness, with a majority of hospice patient family survivors receiving their initial hospice information from relatives. Implications of these results and issues for future research are identified.