The social structure of the hospice decision

Two complementary studies examined social structural dimensions of discussions and decisions to enter hospice care. In Study 1, intensive interviews were conducted with caregivers, patients, "other" decision makers, and physicians for 150 hospice cases. In Study 2, survivors of cancer deaths were surveyed by mail. Data from Study 1 showed that the discussion was likely to be initiated by a professional outside the patient's household, that the number of actual participants in the discussion was small, that social network--friends and relatives--were important during the communication and discussion processes, and that the decision to enter hospice care was likely to be made by the caregiver. Data from Study 2 showed the importance of the timing of communications about hospice. Both studies revealed high levels of awareness of hospice care, as well as how social networks, particularly friends and relatives, serve to communicate information about hospice. Implications for the timing of communications related to hospice care, as well as for future research and models of decision-making are discussed.