Who Are Hospice Patients and What Care Is Provided in Hospices? A Pilot Study.
Remco M Koorn, Merel van Klinken, Everlien de Graaf and 4 others
PMID 31835931WHAT IT FOUND
Hospice records were usually obtainable, but many patient and care details were missing, especially symptoms and psychosocial or spiritual information.
Collection was possible but slow and uneven.
Key findings
01Physician and nurse records were available in 95% and 98% of cases, but volunteer records were available in only 62%, and obtaining records took 21.7 days on average.
02Symptoms experienced were documented in only 10% of records, and variables covering physical, psychological, social and spiritual status were available in 47%.
03Most recorded interventions in the first 72 hours were in the physical dimension (65%), with pain (14%), pressure ulcer prevention (9%) and dyspnea (5%) the most common targets.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a pilot study, not a test of whether hospice care works. Only 13 of 16 approached hospices participated, and only 2 volunteer-driven hospices were included, so volunteer-driven hospices are underrepresented. The study planned 120 records but obtained 104, and hospices selected half of the records; staff said they chose complex cases, which may bias the patient descriptions. Only the first 72 hours after admission were reviewed, so later symptoms, care changes and end-of-life details may be missed. Missing data were not filled in, and some items were based on one electronic record system, so availability may not reflect all hospice documentation systems. The study describes records, not patient experiences or outcomes, so it cannot say whether care was adequate or whether patients wanted more attention to social and spiritual needs.
Declared interests
The authors declared no potential conflicts of interest and no financial support for the research, authorship or publication, while the funding section names ZonMw.
The easy way to misread this
Do not conclude that patients had few symptoms or that hospices ignored psychosocial and spiritual needs. The low documentation rates show what was recorded, not what patients experienced, because symptoms were documented in only 10% of records and the study did not test care quality.