Low Hospice Utilization in New York State: Framework for Compiling and Ranking Barriers

Area of Science:

• Health Services Research
• Palliative Care
• End-of-Life Care

Background:

• The hospice benefit offers improved end-of-life outcomes but faces underutilization, particularly in states like New York.
• Understanding the specific barriers to hospice utilization is crucial for improving access.

Purpose of the Study:

• To compile and rank barriers to hospice utilization.
• To identify barriers specific to New York compared to the rest of the United States.
• To suggest interventions for improving hospice access.

Main Methods:

• A mixed-methods study involving clinicians, administrators, and hospice employees.
• Nominal group technique sessions were conducted across New York State.
• Barriers were categorized, ranked, and analyzed thematically, with a focus on New York-specific issues.

Main Results:

• Fifty-seven participants identified and ranked 54 barriers across nine categories, including clinician and patient factors, and healthcare system structures.
• Thirteen barriers were consistently ranked high, with 10 identified as specific to New York.
• Thematic analysis revealed 14 key barriers in New York and proposed 11 interventions.

Conclusions:

• A systematic categorization and ranking of barriers can inform targeted interventions to address low hospice utilization.
• Further research involving diverse stakeholders is needed to enhance hospice access.