Essay: Hospice Utilization Open the Powerpoint

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¶ … Hospice Utilization

Open the PowerPoint presentation

Under the SLIDE SHOW tab click on the <

ehears Timings> to set how long a slide will stay visible by reading the text. Clicking on the close "X" in the upper right hand corner of the small window terminates that session. The program asks whether the slide timing should be saved.

The actual voice recording can be made by clicking on <

ecord Narration> above the <

ehearse Timings> command button.

Check whether the narration/soundtrack is working by going to the VIEW menu tab and click on button command (or F5).

Hello, my name is Geraldine Bovden and I am an advanced practice nursing student working towards a degree in ***********. The topic I chose for my research project was the barriers to hospice utilization.


A number of research studies have revealed that hospice care outperforms hospital inpatient care in a number of ways. Temel and colleagues looked at patients with metastatic lung cancer and discovered that when patients took advantage of hospice services quality of life improved, depressive symptoms were less severe, and survival was extended by just under three months. McGorty and Bornstein reviewed the research literature concerning the financial advantages of hospice care and found a 13-20% savings compared to standard care. The savings increased to 40% during the last month of life.

In light of these advantages I felt it was important to understand the barriers perceived to be preventing fuller use of hospice services from the perspective of career nurses.

Slide 3

Determining whether hospice care is underutilized in America is not a straightforward task. McGorty and Bornstein reviewed the data addressing this question and focused on the fact that 60% of all cancer deaths in England happen in hospice care, yet in the U.S. this statistic is only 42%. This comparison suggests that American cancer patients are underutilizing palliative care by almost 20% compared to their British counterparts.

Slide 4

A number of barriers explaining hospice underutilization in the U.S. have been identified by researchers. For example, McNeilly and Hillary discovered that only 24% of physicians were familiar with the services provided by hospice care. This is important because it implies that three quarters of primary care physicians have little understanding of what advantages palliative care provides.

Another frequently cited barrier is physicians overestimating patient longevity. One estimate by Chistakis and Lamont suggested that 63% of physicians fall into this category. Given the current requirements for patients to have no more than six months to live in order to receive coverage for hospice services under Medicare and Medicaid, determining a fairly accurate estimate of longevity is important. In truth, the median survival of patients referred to hospice care is about a month following admittance and almost 50% die within two weeks. Based on this data hospice care is clearly underutilized in the United States.

The other frequently mentioned barriers include physicians feeling uncomfortable about discussing end-of-life care with patients, physicians unwilling to 'give up' on patients, patients and families unfamiliar with hospice care, and patients and families unwilling to face the inevitable. Administrative hurdles have also been cited as a significant barrier, including the requirement that patients have less than six months to live before receiving hospice services.

Slide 5

Under the Patient Protection and Affordable Care Act of 2010 the primary care role of nurse practitioners will continue to expand and this role will include making referrals for hospice services. To better understand the barriers to hospice care utilization in the U.S. A sample of advanced practice nurses and their instructors were asked to participate in a survey. Demographic information was collected and several questions were asked about perceived barriers to hospice underutilization.

Slide 6

Students and instructors were asked to complete a 10-item questionnaire. All study subjects were made aware that participation in the survey was completely voluntary and that they could decide to not participate at any time. Completed questionnaires could be submitted in person, by mail, or through the use of a drop box.

Slide 7

First a bit of demographic information. Survey respondents were primarily career nurses with over a decade of nursing experience, but very little of this experience was obtained while working within a hospice care organization. 62.5% of respondents had at least 16 years of experience and 80% had over 11 years. However, the vast majority of respondents had less than two years of direct hospice care experience. In hindsight, I should have included a fifth category for nurses with no hospice care experience.

Slide 8

The data presented on the previous slide is consistent with the possibility that most survey participants have experience with end-of-life planning and making referrals for hospice services. This hypothesis was confirmed by the answers to two survey questions. The first revealed that 52% of respondents at least occasionally helped with end-of-life planning, while the second showed very little experience providing end-of-life care.

Slide 9

Given the nursing experience of the survey respondents, this group would be expected to have considerable professional insight into the causes of hospice care underutilization from the perspective of hospice gatekeepers. The next slides present the data generated by their responses when asked about this topic.

Slide 10

The most obvious first question would be whether the survey respondent felt that hospice care is underutilized in America. 66.7% strongly agreed and another 29.2% agreed. When combined, 96% of respondents believed that hospice care is underutilized in this country. This data suggests that career nurses with years of primary care experience, who sometimes help patients plan end-of-life care, are almost universally convinced that hospice care is underutilized in this country. This finding begs the question of why hospice is underutilized.

Slide 11

Based on the research literature the possible causes of hospice underutilization can be grouped into three major categories:

1. those associated with the gatekeepers to hospice care

2. those associated with the patient and their families

3. And administrative hurdles.

Survey respondents were asked to rank these three categories in order of importance.

Slide 12

As this slide shows, survey respondents believed that physician/NP-associated barriers play the most important role in preventing greater hospice utilization. Patient and family barriers were second in importance and administrative hurdles were last. It should be noted, however, that the magnitude of differences between the rankings is modest, which suggests that more than a few respondents ranked these categories in a different order. If this slide were to be summarized it would be that physician/NP-associated barriers play a prominent role in hospice underutilization, but these are clearly not the only barriers.

Slide 13

In light of the data showing physician and nurse practitioner-associated barriers are perceived to play an important role in hospice underutilization, respondents were asked to rank in order of importance several predicted barriers from this category. These barriers were taken from an excellent review on this topic by McGorty and Bornstein.

Slide 14

Of the five possible barriers presented to respondents the top ranked was "physicians and nurse practitioners uncomfortable talking about death with their patients." The second most important barrier was gatekeepers unfamiliar with hospice services. The middle ranking goes to physicians and nurse practitioners unwilling to give up on patients. The differences between these three categories, however, are modest, which suggests that all three may contribute to hospice underutilization. Coming in last were physicians and nurse practitioners who overestimated the life span of patients or having a poor opinion of hospice services.

Slide 15

All the survey questions up to this point presented respondents with a selection of multiple-choice answers, which limited the ability of the survey instrument to gather information about barriers not already described in the research literature. To minimize the chances of missing important information about the barriers of hospice underutilization the final question on the survey asked respondents to provide an open-ended essay answer about which barriers they believed were preventing greater hospice utilization. The answers were then assigned to one of several barrier categories. When respondents listed multiple barriers that could be assigned to more than one category, each category assignment was counted once. This resulted in some respondents contributing more than once to the data for this question.

Slide 16

The rankings of the essay answers revealed that physician and nurse practitioner-associated barriers remained among the most important, however, patient and family-associated factors were at least equivalent. Patient and family unfamiliar with hospice services, patient fear of dying, and family unwilling to face end-of-life care decisions were mentioned frequently by respondents. Mentioned less frequently were physicians and nurse practitioners uncomfortable talking about end-of-life care with patients, administrative hurdles, and ICU and emergency department procedures. Not a single respondent mentioned physicians and nurse practitioners overestimating life span, having a poor opinion of hospice care, or being unwilling to 'give up' on patients. Based on this data the primary barriers to greater hospice utilization are the hospice gatekeepers, along with the patients they treat and their families.

Slide 17… [END OF PREVIEW]

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Cite This Essay:

APA Format

Hospice Utilization Open the Powerpoint.  (2013, November 17).  Retrieved April 20, 2019, from

MLA Format

"Hospice Utilization Open the Powerpoint."  17 November 2013.  Web.  20 April 2019. <>.

Chicago Format

"Hospice Utilization Open the Powerpoint."  November 17, 2013.  Accessed April 20, 2019.