At the eleventh hour: psychosocial dynamics in short hospice stays.
OBJECTIVE
This study explored the psychosocial dynamics of short hospice stays (less than 2 weeks) of cancer patients age 65 and older.


METHODS
In-depth interviews with 59 caregivers of 50 patients were audiotaped, transcribed, and coded by using Atlas ti software.


RESULTS
A descriptive typology is presented. A late diagnosis (n = 22 or 44%) was one in which cancer was diagnosed between 2 and 4 weeks before death, rendering earlier hospice admission impossible. Late diagnoses were made because the cancer was missed, masked by comorbidities, or the person resisted seeing a health care provider. A known diagnosis (n = 25 or 50%) was one in which the diagnosis was made long before hospice admission; admission was delayed because the person elected ongoing curative treatment until the final days of life, or the family managed the care without hospice until a turning point (medical, functional, pragmatic, or emotional) occurred, making the care unmanageable.


CONCLUSIONS
Hospice utilization is influenced by the interrelationship among patient-family-provider factors. Understanding the characteristics and needs of subgroups of terminally ill people is key to providing good care at life's end.
Waldrop
Deborah P
DP
University at Buffalo School of Social Work, 633 Baldy Hall, Box 601050, Buffalo, NY 14260, USA. dwaldrop@buffalo.edu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009518:New York; D011584:Psychology; D036301:Qualitative Research; D013727:Terminal Care