title: How hospice staff members prepare family caregivers for the patient's final days of life: an exploratory study.
abstract: BACKGROUND
  There is widespread agreement that the families of hospice patients need to be prepared for the final days of life, yet current practices preparing families are not well described. Examining the gap between family needs and current practice will inform the development of effective preparatory interventions.
  
  
  OBJECTIVE
  The purpose of the study was to describe how hospice clinicians prepare family for the final days of life, including (1) the content of the preparatory information, (2) strategies and timing of preparation, and whether the preparation is tailored, and (3) who prepares families.
  
  
  METHODS
  Conventional content analysis guided this study. Individual interviews using semi-structured questions were conducted.
  
  
  METHODS
  In all, 19 hospice clinicians who provided care in the home setting from two hospice agencies in the United States participated.
  
  
  RESULTS
  Preparatory messages included information on signs of impending death, symptoms, implications of the symptoms, what to expect next, and instructions on what to do. Commonly used strategies included listening, engendering trust, repetition, collaboration with other disciplines, and demonstrations. Staff tailored content and delivery of messages on patient, family, and hospice factors. Preparation usually occurred over time. All hospice staff provided preparatory information, but there are some differences by discipline.
  
  
  CONCLUSIONS
  Most content previous identified as necessary for preparedness is part of the current preparation. The knowledge of the current practice in preparing families can be used to develop systematic means of assessing the factors related to timing and tailoring, which may assist in developing preparatory messages that are effective and timely.
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Madison, WI, USA kkehl@wisc.edu.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kehl
mesh_terms: D000328:Adult; D003142:Communication; D005190:Family / Q000523:psychology*; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D036301:Qualitative Research; D011787:Quality of Health Care; D013727:Terminal Care; D035502:Trust; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Family; caregivers; hospices