Bereaved hospice caregivers' views of the transition to hospice

This study was conducted to explore the communication process between patients, caregivers, and health care professionals, including social workers, through which the decision to choose hospice occurred. Ten bereaved hospice caregivers of patients over age 60 receiving home hospice services participated in this qualitative (phenomenological) study. They represented a range of patient and caregiver characteristics such as age, ethnicity, diagnoses, length of hospice service use, and caregiver relationship to patient. A semi-structured interview guide was used to capture key components in the end-of-life communication process, including discussions caregivers had with health care professionals regarding patients' diagnoses, prognoses, end-of-life care treatment options, and eventual referral to hospice. Themes that emerged included: involvement of health care professionals, relationship with physicians, involvement of patients in decisions, content of discussion, understanding of hospice, and suggestions for improvement. Physicians and social workers were noted to be most involved in the communication, decision making, and transition to hospice; however, a need exists for a more coordinated approach to discussing end-of-life care options with seriously ill patients and their families.