title: Hospice decision making: diagnosis makes a difference.
abstract: OBJECTIVE
  This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision.
  
  
  METHODS
  This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM.
  
  
  RESULTS
  A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase.
  
  
  CONCLUSIONS
  Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.
authors.affiliation: University at Buffalo School of Social Work, 685 Baldy Hall, Buffalo, NY 14260, USA. dwaldrop@buffalo.edu
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Waldrop
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Meeker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D017051:Hospice Care / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D011379:Prognosis; D036301:Qualitative Research; D012189:Retrospective Studies; D012944:Social Support; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors