Improving hospice outcomes through systematic assessment: a clinical trial.
BACKGROUND
Systematic assessment is vital to palliative care, but documentation confirming completion of systematic assessment in hospice settings is often inadequate or absent.


OBJECTIVE
The objective of the study was to determine the efficacy of systematic feedback from standardized assessment tools for hospice patient-caregiver dyads in improving hospice outcomes compared with the usual clinical practice.


METHODS
The sample of patients (n = 709) newly admitted to hospice home care in 2 hospices had designated family caregivers. The interdisciplinary teams (IDTs) caring for these dyads were randomly assigned to either experimental (n = 338) or control (n = 371) conditions. Data were collected from both groups of dyads using standardized assessments on admission and 1 week after each of the first 2 IDT meetings in which these dyads were discussed. The experimental intervention consisted of reporting data from the standardized assessments to the IDTs.


RESULTS
Results showed improved patient depression (P < .001) as a result of the intervention and improvement in both groups in patients' quality of life (P < .001). No other patient outcomes (symptom distress, spiritual needs) or caregiver outcomes (depression, support, spiritual needs) were significantly different.


CONCLUSIONS
Assessment of depression added to usual care probably had an effect because it is not normally a focus of hospice staff. Hospice care was so good during the study that overall quality of life improved as a result of standard care and left little room for improvement in other variables.


CONCLUSIONS
Systematic assessment of depression is needed in hospice patients. No caregiver variables changed, which may indicate a need for a focus on caregivers.
McMillan
Susan C
SC
College of Nursing, Center for Hospice, Center for Hospice, Palliative Care and End of Life Studies at USF, University of South Florida, Tampa, Florida 33612, USA. smcmilla@health.usf.edu
Small
Brent J
BJ
Haley
William E
WE
D000368:Aged; D017028:Caregivers / Q000523:psychology*; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D005260:Female; D006305:Health Status Indicators; D017051:Hospice Care / Q000379:methods* / Q000523:psychology / Q000592:standards*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D011594:Psychometrics; D011786:Quality Control; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome