At the eleventh hour: Psychosocial dynamics in short hospice stays

Abstract

Purpose: This study explored the psychosocial dynamics of short hospice stays (less than 2 weeks) of cancer patients age 65 and older. Design and Methods: In-depth interviews with 59 caregivers of 50 patients were audiotaped, transcribed, and coded by using Atlas ti software. Results: A descriptive typology is presented. A late diagnosis (n = 22 or 44%) was one in which cancer was diagnosed between 2 and 4 weeks before death, rendering earlier hospice admission impossible. Late diagnoses were made because the cancer was missed, masked by comorbidities, or the person resisted seeing a health care provider. A known diagnosis (n = 25 or 50%) was one in which the diagnosis was made long before hospice admission; admission was delayed because the person elected ongoing curative treatment until the final days of life, or the family managed the care without hospice until a turning point (medical, functional, pragmatic, or emotional) occurred, making the care unmanageable. Implications: Hospice utilization is influenced by the interrelationship among patient-family-provider factors. Understanding the characteristics and needs of subgroups of terminally ill people is key to providing good care at life's end. Copyright 2006 by The Gerontological Society of America.