Attitudes towards Death, Perceptions of Hospice Care, and Hospice Care Needs among Family Members of Patients in the Intensive Care Unit

Development of a Hospice Perceptions Instrument for Diverse Patients and Families: Establishing Content and Face Validity

CONTEXT

For many, the perception of "hospice" is synonymous with "death." Even clinicians struggle to have conversations that distinguish between hospice and palliative care for fear that discussing hospice may diminish hope. To date, there are no existing measurement tools to evaluate patient and family perceptions of hospice care.

OBJECTIVE

This research aimed to develop a Hospice Perceptions Instrument (HPI) to capture these perceptions among diverse patients and families.

METHODS

Building on previous studies and literature, 79 potential items were drafted for the instrument. Our interprofessional team independently and collectively evaluated these, resulting in 36 items rated on a 5-point Likert scale. Overarching domains include (1) hospice philosophy and definitions; (2) hospice services; (3) values; and (4) counter-perceptions. Sixteen national subject matter experts from various professions and roles were invited to participate in the content-validity index and five hospice caregivers were invited to participate in face validity.

RESULTS

Fourteen experts responded, with ten meeting inclusion criteria: one physician, four nurses, three social workers, and two chaplains. Six of the ten identified as Black. Three items were removed (I-CVI ranged from 0.5-06), and nine items were revised (I-CVI ranged from 0.6-07). The overall Content Validity Index (CVI) was 0.83, indicating excellent content validity. After revisions, five hospice caregivers assessed face validity and no changes were made based on feedback.

CONCLUSION

Results reveal a disconnect between professional expertise and patient/family voices related to hospice perceptions. Development of this instrument invites a better understanding of perceptions leading to new opportunities for patient/family engagement.

Integrating the Various 'M' Principles of Management into the Establishment of a Palliative Care Service

When it comes to medical caregiving, palliative care (PC) is a multidisciplinary strategy that has the goal of improving quality of life while also alleviating suffering. The doctrine of care for persons with life threatening or debilitating illnesses, as well as bereavement assistance for their families, is based on an organised, highly structured system of providing care to people with life-threatening or debilitating illnesses for the course of their lives. A coordinated continuum of care must be guaranteed throughout multiple healthcare settings, including the hospital, the patient's home, the hospice and long-term care institutions. It is essential for patients and clinicians to communicate and make decisions jointly. It is the goal of PC to provide pain relief and emotional and spiritual support to patients and the people who care for them. The best way to ensure the plan's success is to have an interdisciplinary multidimensional team of medical professionals, nurses, counsellors, social workers and volunteers coordinate it. Due to the alarming projections of cancer incidence over the next few years, a lack of hospices in developing countries, inadequate inclusion of PC, high out-of-pocket expenses for cancer treatment and the resulting financial burden on families, there is a critical need for PC and cancer hospices. To establish PC services, we stress the importance of the various M principles of management, which are divided into the following categories: Mission, Medium (setting), Men, Material including medications and Machines, Methods, Money and Management. These principles are discussed in greater detail later in this short communication. We believe that if we follow these principles, we will be able to establish PC services ranging from home-based care to the provision of care in tertiary care centres.