title: Family evaluation of hospice care: Examining direct and indirect associations with overall satisfaction and caregiver confidence.
abstract: OBJECTIVE
  The Family Evaluation of Hospice Care (FEHC) survey is widely employed by hospices, and several studies have examined this information to help inform and enhance end-of-life services. However, these studies have largely focused on examining relatively straightforward associations between variables and have not tested larger models that could reveal more complex effects. The present study aimed to examine the direct and mediating (i.e., via information/education, patient care, and family support) effects of demographic factors, length of stay, timing of referral, patient symptom severity, location of services, and relationship to caregiver on two outcome variables: overall satisfaction and caregiver confidence.
  
  
  METHODS
  Surveys were collected from 3226 participants who had lost a loved one who received hospice services. Structural equation modeling was employed to examine the direct and mediating effects of the independent variables on the two outcomes of interest.
  
  
  RESULTS
  Participants reporting on racial minority patients, patients with more symptoms, and those referred too late or too early were the most likely to express some discontentment with hospice services. The information/education these individuals received was the only mediating factor significantly associated with caregiver confidence. More positive perceptions of patient care and information/education were both significantly related to greater overall satisfaction.
  
  
  CONCLUSIONS
  These findings help to (1) pinpoint those most at risk for being less satisfied with hospice, (2) identify which aspects of care may be most strongly related to overall outcomes, and (3) provide a model for examining complex associations among FEHC variables that may be employed by other researchers.
authors.affiliation: Department of Psychology,University of Nevada,Las Vegas,Nevada.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Holland
authors.affiliation: Department of Sociology,University of Nevada,Las Vegas,Nevada.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Keene
authors.affiliation: School of Social Work,University of Nevada,Las Vegas,Nevada.
authors.forename: Abbie
authors.initials: A
authors.lastname: Kirkendall
authors.affiliation: Nathan Adelson Hospice,Las Vegas,Nevada.
authors.forename: Nora
authors.initials: N
authors.lastname: Luna
mesh_terms: D001601:Bereavement; D005069:Evaluation Studies as Topic; D005190:Family; D005260:Female; D017051:Hospice Care / Q000592:standards*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010549:Personal Satisfaction; D011795:Surveys and Questionnaires
keywords: Caregivers; End of life; Hospice; Mediation; Palliative care; Satisfaction; Self-efficacy