Improving Hospice Outcomes through Systematic Assessment

Modified Emanuel & Emanuel (1998) model for a peaceful death
October 11, 2015 |  NCBI
by Susan C. McMillan, PhD, ARNP, FAAN – College of Nursing, Center for Hospice, Palliative Care and End of Life Studies at USF, University of South Florida, Tampa, Florida
Brent J. Small, PhD and  William E. Haley, PhD – School of Aging Studies and Center for Hospice, Palliative Care and End of Life Studies at USF, University of South Florida, Tampa, Florida.

INTRODUCTION

Patients near the end of life experience a variety of symptoms that cause distress, and family caregivers also are distressed and at risk for depression. Systematic assessment is a vital part of palliative care, but documentation confirming completion of systematic assessment in oncology and hospice settings is often inadequate or absent.16 Studies with cancer patients have demonstrated that improving assessment can improve pain outcomes79, but these studies have not been conducted in hospice or palliative care settings and have focused only on pain.

Depression is common in cancer and under-diagnosed by health care providers, including in hospice.1011Providing feedback to professionals from standardized depression scales improves such detection.10Although there is little research about assessing depression in hospice patients, we have found in our local hospice that psychosocial assessments were missing the check-offs for depression about 75% of the time.

Attempts have been made to change care provider assessment behaviors with mixed results. Traditional methods such as providing practice guidelines for physicians, and physician conferences are generally ineffective in changing provider behavior without additional incentives or practice change interventions.1116 One important component of effective clinical change models is providing quantitative data on important outcomes.2,4,6,1720

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