Purpose: Despite the proliferation of hospice services during the past 15-20 years and the advantages to holistic medical care, only 29% of those who died in 1999 received hospice care (Ogle, Mavis, & Wyatt, 2002). Open, honest, and timely discussions of end-of-life care options, including hospice, can lead to increased quality of life for patients and families (Steinhauser, Christakis, Clipp, McNeilly, McIntyre, & Tulsky, 2000). This study was conducted to explore psychosocial factors in the communication process between patients, families, and health care professionals, including social workers, which may affect decisions to choose hospice.

Method: A survey was sent to primary caregivers of all patients (from three participating hospice agencies) that died at home within three to six months prior to the mailing (total of 341). These bereaved hospice caregivers' (n=108) responded to questions regarding communication about the patients' serious illness and end-of-life care options and involvement of various health care professionals in the process.

Results: For 61% of the caregivers, initial discussion about the seriousness of the patient's illness and end-of-life care options occurred six months or less prior to patient's death and 81% had this discussion with a physician. Often, more than one discussion was held and other professionals were involved throughout the decision making process (consistent with a study by Chen, Haley, Robinson, & Schonwetter, 2003). In most situations, physicians initiated the discussion of hospice. When asked who else discussed hospice with the caregivers, social workers were mentioned most often (42.2%), followed by nurses (27.7%). Social workers were perceived by these respondents to be most knowledgeable about end-of-life care options (M=4.23, SD=.84), most comfortable with end-of-life care discussions (M=4.13, SD=.94), and most available throughout the decision-making process (M=4.22, SD=.89); followed by nurses, hospital clergy, “other” physicians, and family physicians. Over one-half of caregivers alone made the decision to accept hospice, however, what made the decision difficult was “fear of losing someone I loved” (58%) and that they “did not want to give up” (52%). Implications for Social Work Practice: Several pivotal roles are carried out by social workers in the discussion of end-of-life care options, including educator, liaison, facilitator, and counselor. Social workers are most available, knowledgeable, and comfortable in discussing hospice and can engage patients, families, and health care professionals in open discussion of serious illness, concerns, and fears surrounding the end of life. Such intervention by social workers in this process may ultimately facilitate decisions to choose hospice and increased quality of life for patients and their families at these critical times.

References: Chen, H., Haley, W. E., Robinson, B. E., & Schonwetter, R. S. (2003). Decisions for hospice in patients with advanced cancer. JAGS, 51, 789-797. Ogle, K. S., Mavis, B. & Wyatt, G. K. (2002). Physicians and hospice care: Attitudes, knowledge, and referrals. Journal of Palliative Medicine, 5(1), 85-92. Steinhauser, K. E. (2000). Factors considered important at the end of life by patients, family, physicians and other care providers. JAMA, 284(19), 2476-2482.