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Hemrajani A, Lo S, Vahlkamp A, Silva A, Limaye S. Concurrent Hospice Healthcare Utilization in the Hematology/Oncology Veteran's Affairs Patient Population. Am J Hosp Palliat Care 2024; 41:906-910. [PMID: 37846638 DOI: 10.1177/10499091231206561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Objectives: Concurrent care is a unique care delivery system that allows patients to receive disease modifying treatments and other supportive interventions while also receiving the traditional benefits of hospice care. The objectives of our observational study were to examine health care utilization, use of cancer-directed therapies and palliative interventions, and location of death in patients enrolled in concurrent care. Methods: 72 hematology-oncology patients at the Hines Veteran's Affairs Medical Center (VAMC) who enrolled in concurrent care from 12/2018-4/2021 were reviewed. Data were summarized with descriptive statistics including medians and percentages. Results: A minority of patients received cytotoxic chemotherapy (27.8%), immunotherapy (20.8%), palliative radiation (20.9%), blood products (11.1%), or invasive pain procedures (4.2%). Patients also used fewer cancer-directed treatments as they approached end of life (24.4% within 30 days of death compared to 13.3% within 14 days of death). Most patients died at home (62.9%) or in inpatient hospice (12.9%) as opposed to the hospital (2.9%). Conclusions: A minority of concurrent care patients received cancer-directed therapies or additional types of health care interventions despite the option to do so. Cancer-directed treatment utilization also decreased as patients approached end of life. Patients enrolled in concurrent care were able to appreciate its benefits for longer, as the average length of stay on concurrent care was nearly 3 months.
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Affiliation(s)
- Anshu Hemrajani
- Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Loyola University Medical Center, Maywood, IL, USA
| | - Shelly Lo
- Loyola University Medical Center, Maywood, IL, USA
| | | | - Abigail Silva
- Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL. USA
| | - Seema Limaye
- Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Loyola University Medical Center, Maywood, IL, USA
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Tate CE, Mami G, McNulty M, Rinehart DJ, Yasui R, Rondinelli N, Treem J, Fairclough D, Matlock DD. Evaluation of a Novel Hospice-Specific Patient Decision Aid. Am J Hosp Palliat Care 2024; 41:414-423. [PMID: 37477279 PMCID: PMC11083913 DOI: 10.1177/10499091231190776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background: We tested a novel hospice-specific patient decision aid to determine whether the decision aid could improve hospice knowledge, opinions of hospice, and decision self-efficacy in making decisions about hospice. Methods: Two patient-level randomized studies were conducted using two different cohorts. Recruitment was completed from March 2019 through May 2020. Cohort #1 was recruited from an academic hospital and a safety-net hospital and Cohort #2 was recruited from community members. Participants were randomized to review a hospice-specific patient decision aid. The primary outcomes were change in hospice knowledge, hospice beliefs and attitudes, and decision self-efficacy Wilcoxon signed rank tests were used to evaluate differences on the primary outcomes between baseline and 1-month. Participants: Participants were at least 65 years of age. A total of 266 participants enrolled (131 in Cohort #1 and 135 in Cohort #2). Participants were randomized to the intervention group (n = 156) or control group (n = 109). The sample was 74% (n = 197) female, 58% (n = 156) African American and mean age was 74.9. Results: Improvements in hospice knowledge between baseline and 1-month were observed in both the intervention and the control groups with no differences between groups (.43 vs .275 points, P = .823). There were no observed differences between groups on Hospice Beliefs and Attitudes scale (3.29 vs 3.08, P = .076). In contrast, Decision Self-Efficacy improved in both groups and the effect of the intervention was significant (8.04 vs 2.90, P = -.027). Conclusions: The intervention demonstrated significant improvements in decision self-efficacy but not in hospice knowledge or hospice beliefs and attitudes.
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Affiliation(s)
- Channing E. Tate
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gwendolyn Mami
- President and CEO, Global Collaborations, LLC, Denver, CO, USA
- Advisory Team Chair, Zion Senior Center, Denver, CO, USA
| | - Monica McNulty
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
| | - Deborah J. Rinehart
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, Denver, CO, USA
| | - Robin Yasui
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Rondinelli
- Division of Palliative Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Treem
- Division of Palliative Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diane Fairclough
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel D. Matlock
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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Davlyatov G, He M, Orewa G, Qu H, Weech-Maldonado R. Are Hospice Google Ratings Correlated With Patient Experience Scores? Evidence from a National Hospice Study. Am J Hosp Palliat Care 2023; 40:1365-1370. [PMID: 36812362 DOI: 10.1177/10499091231160186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background: Choosing hospice care for your loved ones is often challenging. Online ratings such as Google rating has become a go-to source for most consumers. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for Hospice also provides quality information about hospice care to help patients and their families make decisions. Aim: To evaluate the perceived usefulness of publicly reported hospice quality indicators and compare hospice Google ratings with hospice CAHPS scores. Methods: A cross-sectional observational study was performed to test the relationship between Google ratings and CAHPS measures in 2020. We conducted descriptive statistics for all variables. Multivariate regressions were used to assess the relationship between Google ratings and the CAHPS scores of the sample. Results: Among our sample of 1,956 hospices, the average Google rating was 4.2 out of 5 stars. CAHPS score means ranged from 75 (Help for pain and symptoms) to 90 (Treating patients with respect) out of 100. Hospice Google ratings were highly correlated with hospice CAHPS scores. For-profit and chain-affiliated hospices reported lower CAHPS scores. Hospice operational time was positively associated with CAHPS scores. The percentage of minority residents in the community and residents' educational level was negatively associated with CAHPS scores. Conclusions: Hospice Google ratings were highly correlated with patients' and families' experience scores as measured by the CAHPS survey. Consumers can use information from both resources in making decisions about hospice care.
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Affiliation(s)
- Ganisher Davlyatov
- Department of Health Administration and Policy, Hudson School of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mengying He
- Department of Management, College of Business and Economics, California State University, Los Angeles, Los Angeles, CA, USA
| | - Gregory Orewa
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haiyan Qu
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Brereton E, Harger G, Matlock DD, Dorsey Holliman B, Tate CE. How Do Patients Describe Hospice Care? A Qualitative Analysis of the Language Used by Older Adults to Describe Hospice Care. J Palliat Med 2022; 25:1692-1696. [PMID: 35944273 PMCID: PMC9836666 DOI: 10.1089/jpm.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Misconceptions about hospice are prevalent and create barriers to hospice enrollment. These misconceptions may be a result of the confusing language around hospice care. Objective: To conduct a content analysis exploring the language used and accuracy in which older adults describe hospice. Design: Participants in two prior studies were asked to describe hospice in their own words. Responses were coded inductively to explore the language used, and deductively to evaluate accuracy in describing hospice. Subjects: Two hundred sixty-six adults, aged at least 65 years or older. Results: The most common language used to describe hospice care related to "comfort," "care," and "family." Most participants accurately describe hospice eligibility, services, and goals of care but inaccurately described location of hospices services. Conclusions: Participants accurately described most of the logistical aspects of hospice care and words such as comfort, care, and family are commonly used to describe services suggesting preferred language for communication interventions. Clinicaltrials.gov (Cohort #1 NCT03794700 and Cohort #2 NCT04458090).
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Affiliation(s)
- Elinor Brereton
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Geoffrey Harger
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel D. Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Channing E. Tate
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Charlton P, Kean T, Liu RH, Nagel DA, Azar R, Doucet S, Luke A, Montelpare W, Mears K, Boulos L. Use of environmental scans in health services delivery research: a scoping review. BMJ Open 2021; 11:e050284. [PMID: 34758992 PMCID: PMC8587593 DOI: 10.1136/bmjopen-2021-050284] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To examine the extent and nature of evidence on the use of the environmental scan (ES) in the health services delivery literature. DESIGN Scoping review. METHODS This scoping review followed the five-stage scoping review methodology outlined by Khalil et al. A Peer Review of Electronic Search Strategies was completed. Seven electronic databases and the grey literature were searched. Pairs of researchers independently performed two levels of screening and data extraction. Data were analysed using qualitative content and thematic analysis. RESULTS Ninety-six studies were included in the scoping review. Researchers conducted ESs for many purposes, the most common being to examine the current state of programmes, services or policies. Recommendations were informed by ESs in 20% of studies. Most common data collection methods were literature review (71%), key informant or semistructured interviews (46%) and surveys (35%). Over half (53%) of the studies used a combination of passive (looking at information eg, literature, policies, guidelines) and active (looking for information eg, surveys, interviews) approaches to data collection. Person sources of data (eg, healthcare stakeholders, community representatives) and non-person sources of data (eg, documents, electronic databases, the web) were drawn on to a similar extent. The thematic analysis of the definitions/descriptions yielded several themes including instrument of discovery, knowledge synthesis, forward-looking and decision making. Research gaps identified included absence of a standard definition, inconsistencies in terminology and lack of guiding frameworks in the health services delivery context. CONCLUSION ESs were conducted to gather evidence and to help inform decision making on a range of policy and health services delivery issues across the continuum of care. Consistency in terminology, a consensus definition and more guidance on ES design may help provide structure for researchers and other stakeholders, and ultimately advance ES as a methodological approach. A working definition of ES in a health services delivery context is presented.
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Affiliation(s)
- Patricia Charlton
- Adjunct Faculty, Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Terri Kean
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Rebecca H Liu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel A Nagel
- College of Nursing, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Rima Azar
- Psychobiology of Stress and Health Lab, Psychology Department, Mount Allison University, Sackville, New Brunswick, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - William Montelpare
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Kim Mears
- Robertson Library, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
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Tate CE, Venechuk G, Pierce K, Khazanie P, Ingle MP, Morris MA, Allen LA, Matlock DD. Development of a Decision Aid for Patients and Families Considering Hospice. J Palliat Med 2021; 24:505-513. [PMID: 33439075 PMCID: PMC7987356 DOI: 10.1089/jpm.2020.0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Hospice is underutilized. Miscommunication, decisional complexity, and misunderstanding around engaging hospice may contribute. Shared decision making (SDM), aided by patient decision aids (PtDAs), can improve knowledge and decision quality. Currently, there are no freely available hospice-specific PtDA to facilitate conversions between patients and providers about hospice care. Objective: To develop a theory-based and unbiased hospice specific PtDA. Design: Guided by the Ottawa Decision Support Framework and International Patient Decision Aid Standards, we used a theory-driven, eight-step, iterative, user-centered approach with multistakeholder input to develop a hospice-specific PtDA for anyone facing end-of-life decisions. Subjects: Feedback was obtained from a 10-member Patient Advisory Panel composed of lay patient advisors; focus groups of hospice providers, family caregivers, and patients; and the Palliative Care Research Group at University of Colorado Hospital consisting of palliative care physicians, midlevel providers, nurses, social workers, chaplains, and researchers. Results: There are many challenges in developing an unbiased hospice decision aid, including (1) balancing the provision of education (eligibility, payment) with decisional support, (2) clarifying values and incorporating emotion, (3) ideally representing the potential downsides of hospice, and (4) adequately capturing and describing care alternatives to hospice. Within this context, we developed a 12-page article and 17-minute video PtDAs. The PtDA openly acknowledges the emotional complexity of the decision and incorporates values clarification techniques to help decision makers reflect and evaluate their goals and preferences for end-of-life care. Conclusions: Hospice decision making is complex and emotional, demanding high-quality SDM aided by a formal PtDA. This work resulted in a freely available article and video PtDA for patients considering hospice. The effectiveness and implementation of these tools will be studied in future research. Clinical Trials Registration (NCT03794700 & NCT04458090).
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Affiliation(s)
- Channing E. Tate
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gracie Venechuk
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kenneth Pierce
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Prateeti Khazanie
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - M. Pilar Ingle
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan A. Morris
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Larry A. Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel D. Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
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Patel MN, Nicolla JM, Friedman FAP, Ritz MR, Kamal AH. Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions. JCO Oncol Pract 2020; 16:803-809. [PMID: 33186083 DOI: 10.1200/op.20.00309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients' biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.
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Affiliation(s)
- Mihir N Patel
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | | | | | - Michala R Ritz
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center, Durham, NC.,Duke Fuqua School of Business, Durham, NC
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Kaimal G, Mensinger JL, Carroll-Haskins K. Outcomes of collage art-based and narrative self-expression among home hospice caregivers. INTERNATIONAL JOURNAL OF ART THERAPY 2020. [DOI: 10.1080/17454832.2020.1752756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Girija Kaimal
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Janell L. Mensinger
- Villanova University, M. Louise Fitzpatrick College of Nursing, Villanova, PA, USA
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Brereton EJ, Matlock DD, Fitzgerald M, Venechuk G, Knoepke C, Allen LA, Tate CE. Content Analysis of Negative Online Reviews of Hospice Agencies in the United States. JAMA Netw Open 2020; 3:e1921130. [PMID: 32049299 PMCID: PMC8409083 DOI: 10.1001/jamanetworkopen.2019.21130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE As online reviews of health care become increasingly integral to patient decision-making, understanding their content can help health care practices identify and address patient concerns. OBJECTIVE To identify the most frequently cited complaints in negative (ie, 1-star) online reviews of hospice agencies across the United States. DESIGN, SETTING, AND PARTICIPANTS This qualitative study conducted a thematic analysis of online reviews of US hospice agencies posted between August 2011 and July 2019. The sample was selected from a Hospice Analytics database. For each state, 1 for-profit (n = 50) and 1 nonprofit (n = 50) hospice agency were randomly selected from the category of extra-large hospice agencies (ie, serving >200 patients/d) in the database. Data analysis was conducted from January 2019 to April 2019. MAIN OUTCOMES AND MEASURES Reviews were analyzed to identify the most prevalent concerns expressed by reviewers. RESULTS Of 100 hospice agencies in the study sample, 67 (67.0%) had 1-star reviews; 33 (49.3%) were for-profit facilities and 34 (50.7%) were nonprofit facilities. Of 137 unique reviews, 68 (49.6%) were for for-profit facilities and 69 (50.4%) were for nonprofit facilities. A total of 5 themes emerged during the coding and analytic process, as follows: discordant expectations, suboptimal communication, quality of care, misperceptions about the role of hospice, and the meaning of a good death. The first 3 themes were categorized as actionable criticisms, which are variables hospice organizations could change. The remaining 2 themes were categorized as unactionable criticisms, which are factors that would require larger systematic changes to address. For both for-profit and nonprofit hospice agencies, quality of care was the most frequently commented-on theme (117 of 212 comments [55.2%]). For-profit hospice agencies received more communication-related comments overall (34 of 130 [26.2%] vs 9 of 82 [11.0%]), while nonprofit hospice agencies received more comments about the role of hospice (23 of 33 [69.7%] vs 19 of 31 [61.3%]) and the quality of death (16 [48.5%] vs 12 [38.7%]). CONCLUSIONS AND RELEVANCE Regarding actionable criticisms, hospice agencies could examine their current practices, given that reviewers described these issues as negatively affecting the already difficult experience of losing a loved one. The findings indicated that patients and their families, friends, and caregivers require in-depth instruction and guidance on what they can expect from hospice staff, hospice services, and the dying process. Several criticisms identified in this study may be mitigated through operationalized, explicit conversations about these topics during hospice enrollment.
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Affiliation(s)
- Elinor J Brereton
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
- Division of Geriatrics, University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Monica Fitzgerald
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
| | - Grace Venechuk
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
| | - Chris Knoepke
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Larry A Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Channing E Tate
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
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