Hospice Placement Research Articles

Predicting hospice appropriateness for patients with dementia of the Alzheimer's type

The appropriateness of admitting individuals to hospice services is determined by assessing the individual's 6-month survival prognosis. Clinical parameters that guide clinicians in assessing prognosis, however, are not well defined in cases of dementia of the Alzheimer's type (DAT) when compared to other illnesses. The Alzheimer's-Hospice Placement Evaluation Scale (AHOPE) was developed to assess the 6-month prognosis of individuals with late-stage DAT. The purposes of this study were to estimate the reliability and predictive validity of AHOPE and to test additional demographic and clinical indicators to determine their added contribution to predicting 6-month survival and hospice appropriateness. Data were collected on 112 long-term care residents with DAT at enrollment and 6 months following enrollment. Initial reliability and predictive validity of AHOPE were supported. Other demographic and clinical indicators were not predictors of 6-month survival. Although additional research is indicated, nurses can use AHOPE to enhance clinical observation and decision making for implementing appropriate care strategies for patients with end-stage DAT and their families. Copyright © 2000 by W.B. Saunders Company

Palliative care teaching and today's general practitioners--is it adequate?

Although only 25% of patients die at home, more than 90% of the terminally ill patient's last year of life is at home under the care of their own general practitioner (GP). In the United Kingdom, doctors training for general practice undergo a 3-year training with 2 years in hospital posts and a year in general practice. This questionnaire study of 33 GPs who had recently completed their vocational training was carried out to ascertain the teaching given on palliative care during the general practice component of training. Very few GPs (15%) had received tutorials on palliative care from within their practice. Less than a third felt they had received adequate teaching on pain and symptom control and fewer than 10% perceived the teaching on psychological support to be adequate. Compared to previous studies, the knowledge of specific therapeutics in palliative care had improved, but several were uncertain of basic principles such as the maximum dose of oral opiates which could be prescribed. The majority (85%) wished to have a placement in a hospice as part of their vocational training. This survey suggests that today's GPs would be very receptive to more focused teaching on palliative care encompassing both symptom control and psychological care during their GP training and would also welcome the opportunity of a hospice placement.