Essay on "Hospice Utilization Open the Powerpoint"

Essay 7 pages (2034 words) Sources: 4

[EXCERPT] . . . .

From the perspective of career nurses enrolled in an advanced practice degree program, patient and family-associated barriers are on their minds the most.

Slide 18

The 24 career nurses that took part in this survey almost uniformly believed that hospice is underutilized by the American medical system. Collectively, they rated physician/NP-associated barriers as most important. Within this category, uncomfortable talking about death with patients, unfamiliarity with hospice services, and an unwillingness to end standard care were cited as most important. Least important were overestimating life span and having a poor opinion of hospice care.

Slide 19

Yet, when respondents were no longer restricted to several prescribed answers they mentioned patient- and family-associated factors twice as often as physician- and nurse practitioner-associated factors. Without the benefit of doing additional research, this finding can be interpreted as patient/family-associated barriers being downstream of physician/NP-associated barriers. In other words, the gatekeepers for hospice access determine the prevalence of patient/family-associated barriers to some extent.

Slide 20

The findings of this study seem to highlight the gatekeeper role of physicians and nurse practitioners and how a lack of hospice knowledge, unwillingness to transition from standard to palliative care, and being uncomfortable talking about death with patients contribute to the prevalence of patient- and family-associated barriers. This is good news, because the barriers associated with gatekeepers is more amendable to change. Information about hospice services and the benefits of such organizations can best be disseminated by physicians and nurse practitioners. However, simply providing detailed information won't be enough if the doctors and nurses are unable to overcome their own fears concerning end-of-life care. The onus for making greater use of hospice services therefore falls on the shoulders of doctors and nurses, who are in a position to help patients and their families make the transition from standard to palliative care.

Slide 21

The most striking discrepancy between the findings presented here and the research literature is the relatively minor role 'overestimating life spans' seems to play, at least from the perspective of the respondents who took part in this survey. Christakis and Lamont found that 63% of physicians overestimated a dying patient's life span in their study. McGorty and Bornstein reviewed the work of others and cited a median length of stay between 23 and 36 days, with nearly half dying within two weeks of admission. These findings clearly support the existence of this barrier, but the nurses who took part in this study did not consider this a significant barrier to hospice utilization when compared to the others.

One way to interpret this discrepancy is that overestimating life spans does not prevent referrals, only full utilization of hospice services once referred. Maybe a policy change that gives gatekeepers a bit more breathing room when making referrals would result in longer stays.

Slide 22

The findings of this study support the conclusion that addressing physician/NP-associated barriers will be the most effective way to improve hospice care utilization in the United States. Doing so will result in more hospice care… READ MORE

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