Hospice Care Organizations Research Articles

Towards a Crisis Management Playbook: Hospice and Palliative Team Members’ Views Amid COVID-19

ContextThe critical role of hospice and palliative care in response to the COVID-19 pandemic is well recognized, but there is limited evidence to guide healthcare leadership through future crises. ObjectivesOur goal was to support future organizational resilience by exploring hospice and palliative team members’ perspectives on crisis leadership during the COVID-19 pandemic in New York City (NYC). MethodsThis qualitative descriptive study used individual, semi-structured interviews of purposively sampled interdisciplinary team members. Enrollment sites were two large NYC metro hospice care organizations and one outpatient palliative care practice. We asked participants to complete a demographic form and a 45–60 minute interview. We used descriptive statistics and thematic analysis, respectively, for data analysis. We triangulated the data by presenting preliminary study findings to a group of clinicians (n=21) from one of the referring organizations. ResultsParticipants (n=30) were professionally diverse (e.g., nurses, physicians, social workers, chaplains, administrators), experienced (mean=17 years; 10 years in hospice), and highly educated (83% ≥ master's degree). About half (n=15) self-identified as white, non-Hispanic, and nearly half (n=13) self-identified as being from a racial/ethnic minoritized group. Two (n=2) did not wish to self-identify. We identified four themes that reflected challenges and adaptive responses to providing care during a crisis: Stay Open and Stay Safe; Act Flexibly; Lead Adaptively; and Create a Culture of Solidarity. ConclusionWhile additional work is indicated, findings offer direction for a crisis management playbook to guide leadership in hospice, palliative care, and other healthcare settings in future crises.

Research attitudes, practice and literacy among Kenyan palliative care healthcare professionals: an observational, cross-sectional online survey

Background:While research is needed to advocate for implementation of global agendas to strengthen palliative care, healthcare professionals’ research literacy must improve to bridge the gap between evidence and practice. A resurgent focus on North-South power disparities, means attention should also focus on understanding low- and middle-income countries’ local agency to implement palliative care research agendas.Methods:An observational, cross-sectional online survey among Kenyan palliative healthcare professionals currently working at any of the palliative and hospice care organizations operational during January – December 2019, using descriptive statistics.Results:Among the 93 survey respondents, participants were mainly nurses (50.54%; n = 47). Regarding research attitudes: all agreed/strongly agreed research was important for their professional work. Over nine-tenths (91.21%; n = 83) reported having the skills to conduct research, and 91.30% (n = 84) wanted to conduct research in their clinical work. 90% (90.21%; n = 83) reported supervisory support to conduct research. A comparable proportion (90.22%; n = 83) would undertake research if they could find funding. Regarding research practice: over two-thirds (70.65%; n = 65) reported ever having had a mentor who encouraged them to do research, while approximately half (50.59%; n = 43) reported reading evidence-based journal articles about once per month and attending monthly in-house meetings on palliative care (56.79%; n = 46). Regarding research literacy: while over two-fifths of respondents described their current research literacy level as ‘none’ or ‘beginner’ (44.56%; n = 41), a comparable proportion described it as ‘intermediate’ (45.65%; n = 42), with 9 (9.78%) stating it was ‘advanced’.Conclusion:The majority of palliative healthcare professionals report having interest, skills and support at work to conduct palliative care research, with a low-to-medium level of research literacy. The current study explored palliative care staff attitudes to, experience in, and literacy with the research process, which is necessary to creating a dialogue on implementing research findings. This study also adds to the global empowerment agenda, addressing inequities in research opportunities and local capacity to own and undertake palliative care research.

Qualities of Culturally and Religiously Sensitive Practice: A Cross-Sectional Study.

Background: Culture and religion influence lived experience and particularly dying and grieving. Research has largely focused on exploring culturally and religiously sensitive practices, but not necessarily in palliative and hospice care or across nations. Acquired knowledge from the more advanced end-of-life care systems (eg the UK) tends to be generalized to other contexts where its cultural appropriation is not tested. Aim: This study explored the different qualities, among hospice and palliative professionals in Cyprus, describing cultural competence, cultural humility, and religious literacy. Design: A cross-sectional study of 41 palliative and hospice professionals in Cyprus, with the use of a 5-point Likert style questionnaire (a = 0.898). Setting: The study took place in Cyprus and participants were recruited from across palliative and hospice care organizations, including the only hospice in Cyprus, Cyprus Association of Cancer Patients and Friends (PASYKAF), and the Cyprus Anti-Cancer Society (CACS). Results: This study found that there are four main qualities that lead to effective culturally and religiously sensitive practice-informed decision-making, respect, adaptability, and nonjudgmental practice. Conclusions: Future education and training of professionals can consider these findings to appropriate approaches in practice that fit the Cypriot end-of-life care context more effectively.

Impact of a Mindfulness Intervention on Hospice Care Worker Safety and Well-Being

Hospice care workers are exposed to the hazards associated with in-home care in uncontrollable environments as well as occupational stress related to caring for terminally ill patients and their families. This study aimed to assess the effectiveness of an abbreviated mindfulness intervention to improve hospice care worker occupational safety performance and well-being. This study used a single-group pre-post design to pilot test an 18-hour mindfulness training as an intervention on self-reported safety performance and well-being among 13 hospice care workers in Colorado. Participants reported statistically increased levels of safety compliance, one component of safety performance, and subjective well-being following the abbreviated mindfulness intervention in comparison to baseline. The findings that mindfulness training can improve self-reported safety compliance and well-being among hospice workers support further testing of the use of abbreviated mindfulness trainings within hospice care organizations to promote worker safety and well-being.

Patient Centered Care and Turnover in Hospice Care Organizations

Hospice care has significantly changed over the past 40 years. The industry has seen a growth in utilization rates, an increase in insurance coverage, and changing governmental funding. To reduce the significant risk of employee turnover, hospice care organizations have responded to these pressures. This study examines whether nursing turnover is affected as organizations respond to environmental pressures for increased patient-centered care (PCC). Does the use of patient-centered approaches to meeting client needs reduce turnover in the nursing staff? Using hierarchical regression to analyze organizational, market, and personnel data from 695 hospices across the United States, this study finds innovative PCC practices are significantly related to reduced nursing turnover.

Slowing Down Medicine: The Plural Worlds of Hospice Care

This ethnography reflects on a non-profit hospice care organization in the Midwestern US where caregivers “slow down” medical care by acknowledging the plurality of forces that constitute the illness experience, philosophically departing from their biomedical, non-hospice counterparts. It demonstrates the ontological effect of “slowing down” and attending to a set of patient problems that extends beyond the biological, or any distinct, domain. The result is a medical world that privileges the embodied, lived expression of disease—rather than the statistical, clinical expression—resulting in medical care that is enmeshed in the variables of everyday life. I therefore situate hospice care in a historical moment witnessing the emergence of a sophisticated and “non-modern” (Latour 1991) form of medical care.

Hospice Patient Evacuation

This study was conducted to provide lessons learned from the experience of a small, rural hospice care organization to an actual crisis that required evacuation of the facility. A process improvement framework using the emergency response certification guidelines was used to first provide details of the incident, second analyze the effectiveness of disaster planning and response in response to an actual crisis, and third discuss the post-event review, lessons learned, and process improvement. This case study revealed 5 emerging themes-disaster can happen at the most inopportune times, facilities should focus on the most likely hazards, written agreements are needed even in small tight-knit communities, redundancy of resources is needed, and disaster planning and response is a process that should be continually improved.

Improving medication therapy management through collaborative hospice care in rural Minnesota

ObjectiveTo evaluate expanded pharmacy services designed to improve medication therapy management for hospice care in rural Minnesota. MethodsDeidentified data were obtained from records kept by the study pharmacy as part of its normal operations. In-depth interviews of key pharmacy personnel and from each hospice care organization were conducted to identify overall themes based on their experiences. Descriptive analysis was conducted for summarizing the findings. Information gleaned from the interviews was documented and themes identified. These themes were used to provide insight for those who may wish to adopt this program for their patient populations. ResultsAt initial enrollment into hospice care, 85% of the patients received at least one recommendation related to their medication therapy. During patients’ enrollment in hospice care, the most common types of problems addressed through pharmacist consults were symptom control (65%), followed by dosage form (15%), medication management (12%), and adverse effect control (8%). ConclusionImplementation and evaluation of this program showed that the structures and processes used were sound and could be transferred to other patient populations. Outcomes from the program were favorable from practitioner, organization, and patient care perspectives.

A study of the effects of innovative and efficient practices on the performance of hospice care organizations

Due to changes in social norms, funding initiatives, and other environmental factors, the business of hospice care has significantly evolved over the past 40 years. There has been an influx of for-profit firms, increased consolidation, and significant funding changes. We have witnessed a growth in utilization rates, an increase in insurance coverage, and improved governmental funding. Hospice care organizations have responded to these pressures by pursuing more efficient and innovative business practices. Drawing upon institutional theory, this study seeks to address whether quality of care provided to hospice patients is affected as organizations respond to environmental pressures for innovative and efficient business practices. This study uses hierarchical regression to analyze data from 111 hospices in California. Innovative practices are positively related to quality of care. However, efficient practices have no significant relationship with quality of care. It appears that incorporating innovative practices is positively related to quality of care. Although cost containment may be necessary for continued survival, efficiency improvement efforts do not seem to lead to improved quality of care.