Hospice Programs Research Articles

A Model of Death Preparedness in Patients With Advanced Cancer: A Grounded Theory Study.

Death preparedness in patients with advanced cancer is an important prerequisite for improving the quality of death. However, there are insufficient studies on death preparedness in patients with advanced cancer, and the level of death preparedness needs to be further improved. To develop a model of death preparedness in patients with advanced cancer. A qualitative approach with grounded theory was used. Data were collected between February 2024 and July 2024 in the oncology wards of the two general hospitals in Wuhan. We recruited 12 patients, 11 family members, 16 nurses and 4 doctors for semistructured interviews. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist. Death preparedness in patients with advanced cancer is a spiralling process whose core components include death awareness, emotional response, hospice programme and reflexive care, and multiple personal, interpersonal and social factors influence it. A model of death preparedness in advanced cancer patients was constructed through rooted theory, revealing its formation and change process. This model deepens the understanding of death preparedness and helps healthcare providers identify patients' preparedness status in advance to provide more targeted support and care. This personalised care enhances patients' quality of life and reduces the psychological burden on them and their families, achieving more comprehensive and humanised end-of-life care. To better understand patients' death preparedness, healthcare providers should focus on patients' cognitive, emotional, behavioural and social needs in the process of death preparation from a multifactorial perspective, and provide targeted support and assistance. No Patient or Public Contributions were included in this paper.

I survived hospice: Live discharges from a Medicare-certified home hospice program

I survived hospice: Live discharges from a Medicare-certified home hospice program

Community Palliative Care: What are the Best Models?

Palliative care seeks to address the physical, psychosocial and spiritual concerns of patients with a life limiting illness and their caregivers. Early referral to palliative care improves symptoms and is the standard of care. This paper evaluates the evidence for different models of community palliative care and looks at the effects of homecare, hospice programs and residential aged care facility (RACF) interventions on symptom management, home death rate and acute health service utilization. It also examines the impact of COVID-19, telehealth, integration and staffing models on the efficacy of community palliative care. Evidence suggests that community palliative care increases the rate of death at home and may improve satisfaction with care, but effect on symptoms and acute health care utilization are less certain. Enrolment in a hospice program may decrease hospitalizations and improve satisfaction. RACF staff training interventions to improve the quality of palliative care provided to residents show mixed results across all indicators. COVID-19 saw a relative increase in the demand for community palliative care, as people opted out of the hospital system. Models of community palliative care that facilitate integration, support primary health providers, and promote technological innovation are worthy of further research.

A holistic approach to supporting death in the home: Implementation of a home hospice program in a northern community–A study protocol

Introduction To enhance support for individuals at end of life to die at home, a new community-driven home-based hospice program was developed–Home Hospice. This wholistic hospice care program, co-designed by hospice care staff, community end-of-life care providers, researchers, and health systems decision-makers, will provide around the clock care to clients and their families. Methods and analysis This mixed methods study, guided by a process evaluation framework, will use secondary client and caregiver data collected as part of regular Home Hospice program processes, as well as primary interview data collected from caregivers at least three months post-death of the client and from hospice staff and volunteers involved in the Home Hospice program. Analysis will include descriptive statistical analysis of quantitative data and thematic analysis employing an inductive and a deductive qualitative analysis approach. Ethics Ethics approval has been received from the University of Northern British Columbia (File No: 6009117). All individuals and caregivers who enroll in the Home Hospice program will be invited to participate in this study. At three months post-death of the client, hospice staff will contact caregivers to ask if they would like to participate in a one-on-one interview with a research team member. Staff and volunteers will also be eligible to participate in one-on-one interviews with research team members. De-identified participant data will be provided by hospice staff to the research team. All participants will provide informed consent prior to participation in the study. Dissemination This study will use an integrated Knowledge Translation/Knowledge Mobilization (iKTKM) lens wherein the research team will work closely and meaningfully with knowledge users and community partners at all stages. Evidence-based and targeted iKTKM products will be created, including community event presentations and social media posts to share findings with participant and community audiences. Further, findings will be disseminated at conferences, workshops, and policy rounds with academic and decision-making audiences. Preliminary and full project findings will be published in high-quality open access journals. Strengths and limitations of this study Co-design of Home Hospice program and evaluation metrics involves researchers, hospice staff, health systems decision-makers, and community members. Evaluation metrics involve prospective collection of service utilization from client, family, hospice, and health systems perspectives. Integrated knowledge translation approach which frames the knowledge dissemination plan for the study findings focuses on a range of audiences, including local citizens, hospice and community end-of-life care providers, health systems decision-makers, and academic professionals. As a one-year pilot study, the number of clients who may be able to participate in this program will be approximately 50 persons.

Tailoring Hospice Care to the Veteran Population.

United States Military Veterans are an increasingly elderly population, and more and more veterans are choosing hospice care at the end of life. These veterans, particularly if they served in combat, can bring unique management challenges and opportunities to a hospice team. This review highlights the physical and psychosocial traumas experienced by many veterans, and discusses how these issues can affect their hospice care. Traumatic injury-related issues such as chronic pain, neuropathic pain, insomnia, and chronic headaches can worsen for veterans at the end of life, and the psychological sequelae of these traumatic events such as Post-Traumatic Stress Disorder (PTSD), Chronic Anxiety, Substance Abuse, and increased risk of suicide can also be magnified during this time. This review details these and other commonly seen service-related comorbidities, and offers evidence-based recommendations regarding their diagnosis and treatment. In addition, it discusses what is important to veterans at the end of life, and provides suggestions on how hospice programs can individualize and optimize their care of this special population. Honoring their service and respecting their sacrifices are also important aspects of "Best Care" for veterans at the end of life, and this review provides suggestions on how to do so and includes a list of resources that can greatly assist hospice programs, veterans, and families in delivering the most respectful, comprehensive, and thoughtful care possible.

Construction of a Home Hospice Care Program for Older Adults at the End of Life with Chronic Diseases in China: A Delphi Method.

With the increasing aging of the population and the increasing incidence of chronic diseases in China, home hospice care services can meet the desire of the older adult with chronic diseases to receive care and die at home. In order to ensure the real application of hospice in families, the goal of the study was to construct a home hospice care program for the older adult at the end of life with chronic diseases based on Harmony Nursing Theory (composed of three parts: harmony needs assessment, harmony mechanism establishment and interpersonal interaction). Through literature review, a qualitative interview and group discussion, the first draft of a home hospice care program for the older adult at the end of life with chronic diseases based on the harmony nursing theory was developed, which was further revised and finalized by combining the Delphi method of expert correspondence with 19 experts and a pilot study with a home hospice care team. A total of two rounds of expert correspondence were conducted. In the first round, 21 questionnaires were distributed and 19 were returned, yielding a recovery rate of 90.48%. In the second round, 19 questionnaires were distributed, and 19 questionnaires were collected. The recovery rate was 100%. The authority of the two rounds of expert correspondence was 0.96, and Kendall's coefficient of concordance (W) was 0.268 and 0.310, respectively. After the first round of Delphi expert consultation, 3 items were deleted, and 12 items were revised. In the second round of Delphi expert consultation, two items were revised. The final version of the home hospice program includes 4 first-level items, 20 second-level items, and 59 third-level items. The home hospice care program based on harmony nursing theory is authoritative and scientific and can provide a reference for the practice of home hospice care for the older adult with chronic diseases.

Emergency department discharges directly to hospice: Longitudinal assessment of a streamlined referral program

Introduction80 % of Americans wish to die somewhere other than a hospital, and hospice is an essential resource for providing such care. The emergency department (ED) is an important location for identifying patients with end-of-life care needs and providing access to hospice. The objective of this study was to analyze a quality improvement (QI) program designed to increase the number of patients referred directly to hospice from the ED, without the need for an observation stay and without access to in-hospital hospice. MethodsWe implemented a QI program in September 2021 consisting of three components: (1) clarification and streamlining of referral workflows, (2) staff/provider education on hospice and workflows, and (3) electronic medical record (EMR) tools to facilitate hospice transitions. The primary outcome was the change in monthly ED-to-hospice cases pre- and post-implementation. We also calculated the monthly incidence rate of ED-to-hospice transfers. The secondary outcome was ED length of stay (LOS). Results202 patients completed ED-to-hospice transfers from January 1, 2019 to February 29, 2024. 98 patients transitioned from the ED to hospice before QI implementation, and 104 patients transitioned after implementation. We observed a slight but insignificant increase in the mean monthly ED-to-hospice cases from 3.16 patients per month pre-implementation to 3.47 patients per month post-implementation (P = 0.46). We found no significant difference in the monthly incidence rate of ED-to-hospice cases before and after implementation (P = 0.78). ED LOS was unaffected (P = 0.21). ConclusionIn this largest study to date on direct ED-to-hospice discharges, a QI program focused on workflow optimization, education, and EMR modification was insufficient to significantly impact ED-to-hospice discharges. Future efforts to increase hospice transitions from the ED should investigate methods to improve patient identification, the impact of in-hospital hospice programs, and coordination with hospital and community teams to support home-based care for those desiring to remain there.

Cancer Care in Resource-Limited Countries: Jordan as an Example.

Jordan, a lower- to middle-income country, is relatively small, but with rapidly growing population and a challenged economy. Cancer is a growing health care problem and currently ranked second, after cardiovascular diseases, as a cause of death. Jordan's national cancer registry continues to suffer from problems mostly related to long lag time in reporting, absence of outcome data, and accurate staging. The number of new patients with cancer diagnosed in Jordan is increasing at an expected, none disturbing rate, fueled by population growth, improving life expectancy, changing population structure that hosts more older population, high rate of obesity, smoking, and lack of adequate exercise. However, age-standardized rate for cancer incidence is significantly lower than Western societies, yet, mortality rate is higher. Despite efforts, cancer is still diagnosed at more advanced stages and at younger age. The Jordan breast cancer program represents a great example of opportunistic screening that led to significant downstaging of breast cancer. Efforts to evaluate the feasibility of screening programs for colorectal and lung cancers are underway. Tremendous efforts resulted in the execution of the largest clinical cancer genetics program in the region that helps identify patients and at-risk relatives for hereditary cancers. Low-resourced countries, including Jordan, will not be able to keep up with the rapidly increasing cost of cancer care. A better access to clinical trials and moving cancer care to ambulatory settings should offset some of this cost. A cancer control program that addresses all issues of cancer care from screening and early detection, through active cost-effective treatment that assures wider access to palliative care, hospice, and survivorship programs under an expanded universal health coverage, is an urgent national health priority.

Describing Medical Aid-in-Dying and Nursing "Leave-the-Room" Policies in California: A Mixed Methods Study.

Transparent patient-centered communication is essential to providing quality hospice care for patients at the end of life. This study aimed to determine and describe the current state of aid-in-dying policies in California and their effect on hospice nursing in response to narratives about leave-the-room policies presenting professional and moral challenges. In total, 97 hospice program policies were analyzed with a focus on the role of nurses at the bedside and intent to discharge patients who pursue medical aid-in-dying. It is necessary to clarify the important role of hospice nurses who care for terminally ill patients pursuing their legal right to assisted dying. The results of this study underscore the need for improved policy transparency and organizational support to enhance hospice engagement, particularly by nurses, with their patients at the end of life.

Virtual Reality Videos for Symptom Management in Hospice and Palliative Care

ObjectiveTo learn more about the effect of virtual reality videos on patients’ symptoms near the end of life, including which are most effective, how long the effect lasts, and which patients benefit the most. Patients and MethodsWe conducted a prospective study of 30 patients in a regional hospice and palliative care program from March 11, 2022, through July 14, 2023. Using a head-mounted display virtual reality, all participants viewed a 15-minute video of serene nature scenes with ambient sounds. Fifteen patients also participated in a second session of viewing bucket-list video clips they selected. Symptoms were measured with the revised Edmonton Symptom Assessment Scale before, immediately after, and 2 days after each experience. Participants rated their bucket-list selections by level of previous experience, strength of connection, and overall video quality. Functional status was also recorded. ResultsNature scenes significantly improved total symptom scores (30% decrease, P<.001), as well as scores for drowsiness, tiredness, depression, anxiety, well-being, and dyspnea. The improved scores were not sustained 2 days later. Overall, bucket-list videos did not significantly improve symptoms. Neither previous experience with an activity nor a strong connection correlated with significant improvement; however, when patients rated video quality as outstanding, scores improved (31% decrease, P=.03). Patients with lower functional status tended to have more symptoms beforehand and improve the most. ConclusionSerene nature head-mounted display virtual reality scenes safely reduce symptoms at the end of life. Bucket-list experiences may be effective if they are high-quality. More infirm patients may benefit the most.

Building a programme theory of a specialist paediatric palliative and hospice care programme: development process and methodological reflection

BackgroundPaediatric palliative and hospice care aims to improve the quality of life of children with life-limiting and life-threatening conditions and their families. The number of these patients has risen significantly in recent years, resulting in an increased need for palliative care for this population. Although the need for paediatric palliative and hospice care is growing, meaningful outcome evaluation to demonstrate its effectiveness as a complex healthcare intervention is in its early stages. For complex interventions (programmes), theory-based evaluations have grown in prominence in recent years. They seek to understand how and why an intervention works by uncovering its underlying mechanisms by means of programme theory. To support both outcome evaluation in paediatric palliative care and a reflective practice of programme theorizing, we aimed to describe the construction of a programme theory for a specialist paediatric palliative and hospice care programme in Austria and to offer a reflective account of its development process.MethodsWe drew on a combination of theory-based evaluation frameworks to construct a programme theory consisting of an action and a change component. Through multiple iterations, incorporating different stakeholders’ perspectives and drawing on different sources of knowledge and theory, we theorized how and why the programme likely achieves its intended outcomes.ResultsThe programme theory outlines the proposed chains of events, causal mechanisms and outcomes of a specialist paediatric palliative and hospice care programme for children and families in several areas corresponding to its main conceptual tenets. Through a range of activities and interventions, the programme triggers coping and adaptation mechanisms that ultimately contribute to family and child wellbeing in physical, psychological, social, and spiritual dimensions. Established trust and partnership between children/families and healthcare professionals as well as a person-centered and family-centered approach were identified as enabling factors.ConclusionsOur findings provide insights into how a specialized paediatric palliative and hospice care programme works to achieve its intended outcomes for children and families. This helps demonstrate its impact, contributing to meaningful outcome evaluation and service improvement.

A Hospice Transitions Program for Patients in the Emergency Department

Patients often visit the emergency department (ED) near the end of life. Their common disposition is inpatient hospital admission, which can result in a delayed transition to hospice care and, ultimately, an inpatient hospital death that may be misaligned with their goals of care. To assess the association of hospice use with a novel multidisciplinary hospice program to rapidly identify and enroll eligible patients presenting to the ED near end of life. This pre-post quality improvement study of a novel, multifaceted care transitions program involving a formalized pathway with email alerts, clinician training, hospice vendor expansion, metric creation, and data tracking was conducted at a large, urban tertiary care academic medical center affiliated with a comprehensive cancer center among adult patients presenting to the ED near the end of life. The control period before program launch was from September 1, 2018, to January 31, 2020, and the intervention period after program launch was from August 1, 2021, to December 31, 2022. The primary outcome was a transition to hospice without hospital admission and/or hospice admission within 96 hours of the ED visit. Secondary outcomes included length of stay and in-hospital mortality. This study included 270 patients (median age, 74.0 years [IQR, 62.0-85.0 years]; 133 of 270 women [49.3%]) in the control period, and 388 patients (median age, 73.0 years [IQR, 60.0-84.0 years]; 208 of 388 women [53.6%]) in the intervention period, identified as eligible for hospice transition within 96 hours of ED arrival. In the control period, 61 patients (22.6%) achieved the primary outcome compared with 210 patients (54.1%) in the intervention period (P < .001). The intervention was associated with the primary outcome after adjustment for age, race and ethnicity, primary payer, Charlson Comorbidity Index, and presence of a Medical Order for Life-Sustaining Treatment (MOLST) (adjusted odds ratio, 5.02; 95% CI, 3.17-7.94). In addition, the presence of a MOLST was independently associated with hospice transition across all groups (adjusted odds ratio, 1.88; 95% CI, 1.18-2.99). There was no significant difference between the control and intervention periods in inpatient length of stay (median, 2.0 days [IQR, 1.1-3.0 days] vs 1.9 days [IQR, 1.1-3.0 days]; P = .84), but in-hospital mortality was lower in the intervention period (48.5% [188 of 388] vs 64.4% [174 of 270]; P < .001). In this quality improvement study, a multidisciplinary program to facilitate ED patient transitions was associated with hospice use. Further investigation is needed to examine the generalizability and sustainability of the program.

Inpatient Hospice Impact on Blood Culture Practices Near the Time of Death, Tertiary Center, Northern California, 2019–2023

Introduction: Many central line-associated bloodstream infections are identified in patients nearing the end of life. Stanford Health Care recently introduced the General Inpatient Hospice program. This program offers inpatient hospice care for patients who, due to uncontrolled symptoms, cannot be discharged to a hospice facility or receive home hospice care. We investigated whether this program would impact blood cultures practices near the time of death. Methods: We performed a retrospective cohort study at Stanford Health Care using records of blood culture events from May 2019 to October 2023. We defined a blood culture near-death as those collected within 2 days before the date of death. We performed an interrupted time series linear regression before and after the implementation of the General Inpatient Hospice program on July 1, 2022 to assess blood culture intensity near-death. Blood culture intensity was defined as the proportion of cultures collected near-death in relation to the total number of blood cultures. Additionally, we calculated blood culture positivity rate, which was defined as the proportion of positive blood cultures among all those collected during our study period. Results: Out of 220,269 blood cultures from 24,955 unique patients, a total of 6,147 cultures (9%) were obtained near the time of death. Among these subjects, the median age was 65 years (range 20–102), with 43% identifying as being of White race-ethnicity and 57% as male. Of these cultures, 3044 were positive (49.5%), with Escherichia coli (618, 24%), Klebsiella pneumoniae (341, 13%), and Staphylococcus aureus (166, 10%) being the most common organisms. After the implementation of the General Inpatient Hospice program, the median enrollment was 12 patients (range 3–18) and the median mortality rate was 2.3% (range 2–3%). The blood culture intensity near death decreased by 0.81%, a change that was not statistically significant (95% CI -2.4% to 0.8%, p=.32; Figure 1). Subsequently, the blood culture intensity showed a non-significant increasing trend of 0.05% (95% CI -0.1% to 0.2%, p=0.53). The blood culture positivity rate near the time of death increased by 16% following the intervention, but this increase was not statistically significant (95% CI – 11.8% to 43.3%, p=.26; Figure 2), and it was followed by a non-significant downtrend of 1.9% (95% CI -3.9% to 1.4%, p=.36). Conclusion: We found no significant association between the implementation of an inpatient hospice program and blood culture practices near the time of death, likely due to low patient enrollment.

간호대학생의 공감교육을 포함한 호스피스 완화간호 교육 프로그램이 공감 능력, 삶의 의미, 호스피스 완화간호에 대한 인식에 미치는 효과

Objectives This study was conducted to determine the effect of a hospice and palliative care education program, including empathy education, on nursing students' empathy ability, meaning of life, and perception of hospice and palliative care in fourth-year nursing students at a university. Methods The research design was a pre-post quasi-experimental design with a non-equivalent control group. The subjects of the study were experimental group 41 and control group 40, in fourth-year nursing students at a Women's College located in I City, the study period was from September 5th to December 6th, 2019. The hospice palliative nursing education program consisted of a total of 26 hours, including the empathy education program developed by Jeong Jin-ok and Kim Su (2019). Data analysis was done using frequency, percentage, mean, standard deviation, Chi-square test, t-test, paired t-test using with spss win 21.0. Results The experimental group that participated in the hospice and palliative care education program that included empathy education was found to have statistically significant differences in cognitive empathy(t=2.092, p=.040), emotional empathy(t=2.013, p=.048), meaning of life(t=2..203, p=.031), and perception of hospice and palliative care(t=2.533, p=.013) compared to the control group. Conclusions The research results show that a hospice and palliative care education program including empathy education improves nursing students' empathy ability, meaning of life, and perception of hospice and palliative care, so it will be helpful in developing and applying various educational methods and programs.

Not Just Small Adults: The Birth and Early Years of a Pediatric Hospice Program

Not Just Small Adults: The Birth and Early Years of a Pediatric Hospice Program

“Stop Imposing on Us”: A Critical Examination of Ethnocultural Considerations in the Canadian Volunteer Hospice Palliative Care Landscape

Volunteers are foundational in hospice programs. The purpose of this research was to address social, ethnic and demographic changes in Southwestern Ontario and understand how this may affect volunteer recruitment, and representation. Interviews and focus groups were conducted with hospice volunteers, key informants from leaders in ethnocultural communities, and hospice staff. Qualitative data from the interviews was analyzed using thematic analysis in five phases. Findings suggest ethnocultural interpretations of hospice can be very different than Westernized, Eurocentric ideas around end-of-life care. Systemic and structural barriers, information sharing, volunteer motivation and representation were found to influence and impact ethnocultural volunteer recruitment in hospice palliative care. Using a critical analysis allows us to identify the “imposition” of a Euro-ethnocentric hospice palliative care model that prevents recruitment of and impedes access of ethnocultural groups to hospice palliative care. To build bridges across predominantly White/Western models of care to ethnocultural racialized communities requires constant communication, relationship building, and determination in mutuality of learning on behalf of the dominant model. This research has implications for different regions of Canada providing hospice palliative care and hoping to increase ethnocultural accessibility and volunteer recruitment for hospice palliative care.

Community-Based Oncology Nursing: Current Status and Prospects – A Secondary Publication

Objective: Currently, it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented. The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature. Methods: A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention, cancer screening, cancer survivor care, and cancer patient hospice care. Results: The Comprehensive Cancer Care Model (CCCM) was established. The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis. On the vertical axis, public health centers, oncology hospitals, cancer convalescent hospitals, primary care physicians, and prayer centers were involved. The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed. Conclusion: It is expected that CCCM will be used for holistic, sustainable, and cost-effective cancer management. In community-based oncology nursing, the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs, while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

Whole Person Care in philanthropy - healing &amp; giving

Static reimbursement, rising expenses and decreasing margins for hospice and palliative care programs in the US, limit funding for innovative and creative education, care-giver well-being and resilience efforts and workforce development. Whole Person Care in philanthropy can lead to healing not only of grateful patients, families and friends but can also be a source of healing, connectiveness and meaning for donors, board members, foundations and the community. &#x0D; This presentation will share leadership practices which engage grateful patients, families, prospective donors, board members, foundations and the community to raise significant funds for innovative education and program development. Conversely, the presentation will share innovative education and program development which engages and excites patients, families, donors, board members, foundations and the community to give significant philanthropic gifts. A small but excellent hospice foundation staff (5 people) with the help and support of the clinical leadership team raised over 4 million dollars in 2022 for a community-based hospice serving over 300 patients/day and community-based palliative programs serving over 600 patients/day, both adults and children.

Grief Training in Palliative Care Fellowships

IntroductionNo prior study has assessed grief and bereavement curriculum in Hospice and Palliative Medicine (HPM) fellowship programs in the United States. MethodsA 14-item survey was created and distributed to Accreditation Council for Graduate Medical Education (ACGME)-accredited HPM fellowship Program Directors to assess program demographics, curriculum emphasis, grief and bereavement programming, and attitudes toward grief and bereavement training for HPM fellows. ResultsThe overall survey response rate was 63%. Most palliative care programs were academic (74%) and had four or fewer fellows (85%). 90% devoted a minority (0%–10%) of their curriculum to grief and bereavement training. Most programs reported at least some program-led grief and bereavement programming (69%); however, 53% endorsed that fellows are not very or not at all involved in this programming. Almost half of programs only have a small amount of programming related to supporting families after loss (49%). The majority endorsed having a great deal of programming for debriefing or supporting fellows through professional grief (55%), and the most common modalities were debriefing sessions (62%) and ensuring access to mental health resources (41%). The most common ways of teaching grief and bereavement were through bedside/anecdotal teaching and lectures/case conferences. Most program directors felt that palliative care fellowships should provide grief and bereavement training (81%) and consider it important or very important for fellows to learn how to process grief and bereavement (92%). DiscussionIt was widely reported by program directors that grief and bereavement training are important curricular components for HPM fellows. Acknowledging professional grief remains an underrecognized need in palliative care training and practice. Our study suggests that for grief and bereavement curricula in HPM fellowships, the time dedicated, specific types, and amount of fellow involvement was highly variable. It will be critical for programs to disseminate best practices to help move toward a more uniform approach for ensuring basic competency in grief and bereavement training in HPM fellowship programs in the United States.

QUALITY OF LIFE ASSOCIATED WITH HOSPITAL DEATH AMONG PERSONS LIVING WITH DEMENTIA

Abstract Dementia is a progressive, terminal health condition impacting quality-of-life. Hospice programs supporting family caregivers in managing end-of-life care for persons living with dementia (PLWD) and preventing non-beneficial hospitalizations are underutilized. This univariable logistic regression of the National Health and Aging Trends Study rounds 1-9 (n=719) aimed to identify associations between quality-of-life of PLWD and hospital death (yes/no). Results indicate that PLWD going outside most days (OR=3.34, p=0.0004) were more likely to die in a hospital compared to those never going outside. Those whose health did not prevent them from enjoying life (OR=2.5, p&amp;lt; 0.0001) were more likely to die in a hospital. PLWD needing &amp;gt;30 minutes to fall asleep (OR=2.43, p=0.002) compared to those never needing &amp;gt;30 minutes to fall asleep, PLWD without problems speaking (OR=1.69, p=0.007), not needing help to eat (OR=1.82, p=0.001), without problems chewing or swallowing (OR=1.54, p=0.039), and having possible dementia (OR=2.35, p&amp;lt; 0.0001) were more likely to die in the hospital. African Americans (OR=1.80, p=0.003) were more likely to die in the hospital compared to Whites, PLWD who received gas energy assistance (OR=1.95, p=0.048), and those living in the Pacific West compared to the Midwest or Northeast (OR=2.57, p=0.004) were more likely to die in the hospital. These findings suggest that quality-of-life, availability of support, financial and psychosocial well-being, and social disparities were associated with higher risk of hospital death among PLWD. Quality-of-life and psycho-social demographic features may serve as mechanistic targets for interventions supporting hospice transitions and prevention of non-beneficial end-of-life hospitalizations.