Missed Opportunity: Hospice Care and the Family

A typical mission statement of hospice services is to provide quality, compassionate care to those with terminal illness and to support families through caregiving and bereavement. This study explored the ways that bereavement needs of caregivers, either predeath or postdeath of their spouse/partner, were addressed using qualitative retrospective phone interviews with 19 caregivers whose spouse/partner was enrolled in hospice care for cancer. Overall, participants expressed high satisfaction with hospice care, most often noting a high satisfaction with the quality of care provided to their spouse/partner. During the predeath phase, caregivers recalled being so focused on their spouse/partner's needs that they rarely spoke with hospice staff about their own personal needs and emotions. Participants said that bereavement counseling occurred primarily after the death of the spouse/partner, in the form of generic pamphlets or phone calls from someone they had not met during prior interactions with hospice staff. These findings suggest that caregivers’ high satisfaction with hospice may be more associated with the quality of care provided to the spouse/partner than with bereavement support they received. Our findings illustrated a potential missed opportunity for hospices to address the family-oriented goals that are commonly put forward in hospice mission statements.

[1]  Kevin K. John,et al.  Addressing Methodological Challenges in Large Communication Data Sets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care , 2016, Health communication.

[2]  R. Utz,et al.  “One Size Doesn’t Fit All”—Partners in Hospice Care, an Individualized Approach to Bereavement Intervention , 2016, Omega.

[3]  Roberto H Valverde,et al.  Trends in Length of Hospice Care From 1996 to 2007 and the Factors Associated With Length of Hospice Care in 2007 , 2014, The American journal of hospice & palliative care.

[4]  J. D’Antonio Caregiver Grief and Anticipatory Mourning , 2014 .

[5]  K. Mooney,et al.  Partners in Hospice Care: A Program Project Grant Exploring and Supporting Family Caregivers During Hospice Care Through Bereavement (SA505) , 2013 .

[6]  R. Neimeyer Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved , 2012 .

[7]  Karl A Matuszewski,et al.  When One Size Doesn't Fit All. , 2012, P & T : a peer-reviewed journal for formulary management.

[8]  A. Trentham-Dietz,et al.  Complicated Grief Symptoms in Caregivers of Persons with Lung Cancer: The Role of Family Conflict, Intrapsychic Strains, and Hospice Utilization , 2011, Omega.

[9]  Pablo Arriaza,et al.  An Assessment of Hospice Bereavement Programs for Hispanics , 2011, Journal of social work in end-of-life & palliative care.

[10]  R. Utz,et al.  Perceived Self-Competency Among the Recently Bereaved , 2011, Journal of social work in end-of-life & palliative care.

[11]  D. Kashy,et al.  Dyadic coping in metastatic breast cancer. , 2010, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[12]  K. Boerner,et al.  Do Spousal Discrepancies in Marital Quality Assessments Affect Psychological Adjustment to Widowhood , 2009 .

[13]  S. Zisook,et al.  Grief and bereavement: what psychiatrists need to know , 2009, World psychiatry : official journal of the World Psychiatric Association.

[14]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[15]  B. Given,et al.  Quality of life of family caregivers of cancer survivors , 2008, Cancer.

[16]  Susan C. Miller,et al.  Bereaved family members' evaluation of hospice care: what factors influence overall satisfaction with services? , 2008, Journal of pain and symptom management.

[17]  Wolfgang Stroebe,et al.  Health outcomes of bereavement , 2007, The Lancet.

[18]  W. Haley,et al.  Bereavement after caregiving or unexpected death: Effects on elderly spouses , 2006, Aging & mental health.

[19]  R. Nesse,et al.  Older Adults' Perceptions of Intergenerational Support After Widowhood , 2006 .

[20]  R. Nesse,et al.  The Daily Consequences of Widowhood , 2004 .

[21]  Michal Hamo From Observation to Transcription and Back: Theory, Practice, and Interpretation in the Analysis of Children's Naturally Occurring Discourse , 2004 .

[22]  S. Denham,et al.  The Ohio Hospice Bereavement Study: Meeting NHPCO standards , 2003, The American journal of hospice & palliative care.

[23]  D. Mylod,et al.  Satisfaction of families using end-of-life care: Current successes and challenges in the hospice industry , 2003, The American journal of hospice & palliative care.

[24]  G. Hagopian,et al.  Patient and caregiver satisfaction with end-of-life care: Does high satisfaction mean high quality of care? , 2002, The American journal of hospice & palliative care.

[25]  R. Utz,et al.  Late-life widowhood in the United States: New directions in research and theory , 2001 .

[26]  J. House,et al.  Psychological adjustment to sudden and anticipated spousal loss among older widowed persons. , 2001, The journals of gerontology. Series B, Psychological sciences and social sciences.

[27]  T. Hungerford The economic consequences of widowhood on elderly women in the United States and Germany. , 2001, The Gerontologist.

[28]  H. Schut,et al.  The dual process model of coping with bereavement: rationale and description. , 1999, Death studies.

[29]  Richard E. Boyatzis,et al.  Transforming Qualitative Information: Thematic Analysis and Code Development , 1998 .

[30]  M. Clayton Caring for Carl at home. , 1996, Home healthcare nurse.

[31]  P. Rousseau,et al.  Hospice and palliative care. , 1995, Disease-a-month : DM.

[32]  D. Owens The spectrum of depressive phenomena after spousal bereavement. , 1994 .

[33]  H. Prigerson,et al.  Socialization to dying: social determinants of death acknowledgement and treatment among terminally ill geriatric patients. , 1992, Journal of health and social behavior.

[34]  Teresa A. Rummans,et al.  Grief counseling and grief therapy: A handbook for the mental health practitioner , 1992 .

[35]  J. Worden,et al.  Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner , 1991 .

[36]  J. Pennebaker Opening up : the healing power of expressing emotions , 1990 .

[37]  J. Kaprio,et al.  Mortality after bereavement: a prospective study of 95,647 widowed persons. , 1987, American journal of public health.

[38]  C. Sanders A Comparison of Adult Bereavement in the Death of a Spouse, Child, and Parent , 1980 .

[39]  T. H. Holmes,et al.  The Social Readjustment Rating Scale. , 1967, Journal of psychosomatic research.

[40]  J. Meyers,et al.  The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. , 2001, Oncology nursing forum.

[41]  S. Zisook,et al.  The spectrum of depressive phenomena after spousal bereavement. , 1994, The Journal of clinical psychiatry.

[42]  M. Gilhooly,et al.  Anticipatory grief: a review. , 1990, Social science & medicine.

[43]  C. Saunders Hospice care. , 1979, Indian journal of cancer.