Does Diagnosis Make a Difference? Comparing Hospice Care Satisfaction in Matched Cohorts of Heart Failure and Cancer Caregivers.
BACKGROUND
Half of heart failure patients will die within five years of diagnosis, making them an ideal population for hospice to reach. Yet hospice originated in oncology, and problems have been noted with the enrollment of heart failure patients. Whether caregiver satisfaction, a key quality measure in hospice, differs between heart failure and cancer caregivers is unknown.


OBJECTIVE
We aimed to determine whether diagnosis makes a difference in satisfaction with hospice care in matched cohorts of heart failure caregivers and cancer caregivers.


METHODS
This was a national cohort study, using caregiver responses to the Family Evaluation of Hospice Care (FEHC) survey. Heart failure and cancer caregivers were matched via propensity scoring. The relationship between diagnosis and caregiver satisfaction was examined across the domains of symptom management, emotional support, caregiver teaching, coordination of care, and global satisfaction, both before and after matching via logistic regression.


RESULTS
One-to-one matching with calipers yielded 7730 matched pairs out of an original sample of 8175 heart failure caregivers and 24,972 cancer caregivers. Significant differences were found in caregiver teaching, emotional support, coordination of care, and global satisfaction prior to matching, but the effect sizes were small. All differences disappeared after matching. High rates of dissatisfaction with caregiver teaching (42%) and emotional support (30%) were found in both cohorts.


CONCLUSIONS
The diagnosis of heart failure, in and of itself, does not appear to make a difference in informal caregiver satisfaction with hospice care. Hospice provides high-quality care for patients, but improvements are needed in caring for the caregiver.
1 College of Nursing, Villanova University , Villanova, Pennsylvania.
Meredith A
MA
MacKenzie
2 School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania.
Salimah H
SH
Meghani
3 College of Nursing, The Pennsylvania State University , University Park, Pennsylvania.
Harleah G
HG
Buck
2 School of Nursing, University of Pennsylvania , Philadelphia, Pennsylvania.
Barbara
B
Riegel
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure; D017051:Hospice Care / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010549:Personal Satisfaction; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D057216:Propensity Score; D012189:Retrospective Studies; D017678:Sex Distribution; D013997:Time Factors