title: Nurses' communication of prognosis and implications for hospice referral: a study of nurses caring for terminally ill hospitalized patients.
abstract: BACKGROUND
  Although nurses are ideally situated to facilitate communication about prognosis and hospice referral among patients, patients' family members, and hospital staff, nurses do not always assume this task.
  
  
  OBJECTIVE
  To identify common obstacles to nurses' discussions of prognosis and referral to hospice care with terminally ill patients in the hospital setting.
  
  
  METHODS
  Data from a previous study were analyzed. In that study, a total of 174 experienced staff nurses working full-time in hospital practice areas where terminally ill patients routinely receive care at 6 randomly selected community hospitals in Connecticut participated. Each nurse completed a self-administered, cross-sectional survey. In this study, the open-ended responses of the nurses were examined by using content analysis and descriptive analysis.
  
  
  RESULTS
  The most common obstacles were unwillingness of a patient or the patient's family to accept the prognosis and/or hospice, sudden death or noncommunicative status of the patient, belief of physicians' hesitance, nurses' discomfort, and nurses' desire to maintain hope among patients and patients' families.
  
  
  CONCLUSIONS
  The reasons for noncommunication of prognosis and referral to hospice care by nurses are complex. Because limited discussion between clinicians and patients about prognosis and treatment options can reduce the likelihood of referral to hospice care, improved communication skills may result in more referrals and a smoother transition to hospice.
authors.affiliation: Center for Excellence in Chronic Illness Care, School of Nursing, Yale University, New Haven, CT, USA.
authors.forename: Dena
authors.initials: D
authors.lastname: Schulman-Green
authors.forename: Ruth
authors.initials: R
authors.lastname: McCorkle
authors.forename: Emily
authors.initials: E
authors.lastname: Cherlin
authors.forename: R
authors.initials: R
authors.lastname: Johnson-Hurzeler
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003142:Communication; D003237:Connecticut; D003430:Cross-Sectional Studies; D005260:Female; D017051:Hospice Care / Q000523:psychology / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D024802:Nurse's Role / Q000523:psychology; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*; D011368:Professional-Family Relations; D011379:Prognosis; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*