Why don't patients enroll in hospice? Can we do anything about it?
BACKGROUND
United States hospice organizations aim to provide quality, patient-centered end-of-life care to patients in the last 6 months of life, yet some of these organizations observe that some hospice-eligible patients who are referred to hospice do not initially enroll.


OBJECTIVE



OBJECTIVE
To identify reasons that eligible patients do not enroll in hospice (phase 1).


OBJECTIVE
To identify strategies used by hospice providers to address these reasons (phase 2).


METHODS
Semi-structured interviews analyzed using content analysis.


METHODS
In phase 1, we interviewed 30 patients and/or family members of patients who had a hospice admissions visit, but who did not enroll. In phase 2, we interviewed 19 hospice staff and national experts.


METHODS
In phase 1, we asked participants to describe the patient's illness, the hospice referral, and why they had not enrolled. We performed a content analysis to characterize their reasons for not enrolling in hospice. In phase 2, we enrolled hospice admissions staff and hospice experts. We asked them to describe how they would respond to each reason (from phase 1) during an admissions visit with a potential new hospice patient. We identified key phrases, and summarized their recommendations.


RESULTS
Reasons that patients hadn't enrolled fell into three broad categories: patient/family perceptions (e.g., "not ready"), hospice specific issues (e.g., variable definitions of hospice-eligible patients), and systems issues (e.g., concerns about continuity of care). Hospice staff/experts had encountered each reason, and offered strategies at the individual and organizational level for responding.


CONCLUSIONS
In hopes of increasing hospice enrollment among hospice-eligible patients, non-hospice and hospice clinicians may want to adopt some of the strategies used by hospice staff/experts for talking about hospice with patients/families and may want to familiarize themselves with the differences between hospice organizations in their area. Hospices may want to reconsider their admission policies and procedures in light of patients' and families' perceptions and concerns.
Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA. vigster@u.washington.edu
Elizabeth K
EK
Vig
Helene
H
Starks
Janelle S
JS
Taylor
Elizabeth K
EK
Hopley
Kelly
K
Fryer-Edwards
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*