Kelley, Kristina

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Geriatric Nursing
Medicine and Health Sciences

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  • Publication
    Timely Transitioning to Hospice: A Needs Assessment with a PACE Program to Improve End of Life Care
    (2019-01-01) Kelley, Kristina
    Background: Hospice care has been proven to improve patient outcomes at the end of life. However, patients frequently die without receiving hospice benefits. The challenge of transitioning patients from care with a life prolonging intent to a comfort focused approach can partly be attributed to poor prognostication or misconceptions about hospice. A Program for All Inclusive Care of Elders (PACE) in Massachusetts identified transitioning to hospice as an area for improvement. Purpose: To perform a needs assessment to gain understanding of the barriers to effective transitions to hospice and to provide education aimed at addressing those barriers. Methods: Subjects included nurses, nutritionists, physical and occupational therapists. These healthcare providers were surveyed to assess facilitators and barriers to hospice transitions. An educational presentation and focus group based on the results was conducted and evaluated using post-surveys. Results: Eleven individuals participated in the needs assessment survey. Lack of communication surrounding end of life care transitions was the most frequently identified barrier to care. The educational intervention focused on communication strategies and the post-survey evaluated participant satisfaction on the topic. Six participants were present for the presentation, 5 completed the post-survey following the intervention and 2 completed the 2-month follow-up. Due to the low response rate for the 2-month follow up it was not clear that there was a change in satisfaction among participants. Conclusion: A needs assessment is valuable in understanding why patients are not receiving adequate hospice services at the end of life. These results can effectively direct interventions that aim to improve care transitions.