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Family evaluation of hospice care: Examining direct and indirect associations with overall satisfaction and caregiver confidence

Published online by Cambridge University Press:  03 July 2014

Jason M. Holland ,
Jennifer R. Keene ,
Abbie Kirkendall  and
Nora Luna
Jason M. Holland*
Affiliation:
Department of Psychology, University of Nevada, Las Vegas, Nevada
Jennifer R. Keene
Affiliation:
Department of Sociology, University of Nevada, Las Vegas, Nevada
Abbie Kirkendall
Affiliation:
School of Social Work, University of Nevada, Las Vegas, Nevada
Nora Luna
Affiliation:
Nathan Adelson Hospice, Las Vegas, Nevada
*
Address correspondence and reprint requests to: Jason M. Holland, Department of Psychology, University of Nevada, Las Vegas, 4505 South Maryland Parkway, Box 455030, Las Vegas, Nevada 89154-5030. E-mail: jmhollnd@gmail.com
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Abstract

Objective:

The Family Evaluation of Hospice Care (FEHC) survey is widely employed by hospices, and several studies have examined this information to help inform and enhance end-of-life services. However, these studies have largely focused on examining relatively straightforward associations between variables and have not tested larger models that could reveal more complex effects. The present study aimed to examine the direct and mediating (i.e., via information/education, patient care, and family support) effects of demographic factors, length of stay, timing of referral, patient symptom severity, location of services, and relationship to caregiver on two outcome variables: overall satisfaction and caregiver confidence.

Method:

Surveys were collected from 3226 participants who had lost a loved one who received hospice services. Structural equation modeling was employed to examine the direct and mediating effects of the independent variables on the two outcomes of interest.

Results:

Participants reporting on racial minority patients, patients with more symptoms, and those referred too late or too early were the most likely to express some discontentment with hospice services. The information/education these individuals received was the only mediating factor significantly associated with caregiver confidence. More positive perceptions of patient care and information/education were both significantly related to greater overall satisfaction.

Significance of Results:

These findings help to (1) pinpoint those most at risk for being less satisfied with hospice, (2) identify which aspects of care may be most strongly related to overall outcomes, and (3) provide a model for examining complex associations among FEHC variables that may be employed by other researchers.

Keywords

Palliative careHospiceMediationSatisfactionSelf-efficacyEnd of lifeCaregivers
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 901 - 908
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Bentler, P.M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246.CrossRefGoogle ScholarPubMed
Browne, M. & Cudeck, R. (1993). Alternate ways of assessing model fit. In Testing structural equations models. Bollen, K. & Long, J. (eds.), pp. 1136–1162. Newbury Park, CA: Sage.Google Scholar
Carlson, M.D.A., Barry, C.L., Cherlin, E.J., et al. (2012). Hospices' enrollment policies may contribute to underuse of hospice care in the United States. Health Affairs, 31(12), 2690–2698.CrossRefGoogle Scholar
Connor, S.R., Teno, J., Spence, C., et al. (2005). Family evaluation of hospice care: Results from voluntary submission of data via website. Journal of Pain and Symptom Management, 30(1), 9–17.CrossRefGoogle ScholarPubMed
Crawley, L.M., Marshall, P.A., Lo, B., et al. (2002). Strategies for culturally effective end-of-life care. Annals of Internal Medicine, 136(9), 673–679.CrossRefGoogle ScholarPubMed
Friedman, B.T., Harwood, M.K. & Shields, M. (2002). Barriers and enablers to hospice referrals: An expert overview. Journal of Palliative Medicine, 5(1), 73–84.CrossRefGoogle ScholarPubMed
Hu, L. & Bentler, P.M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.CrossRefGoogle Scholar
Johnson, K.S., Kuchibhatla, M. & Tulsky, J.A. (2008). What explains racial differences in the use of advance directives and attitudes toward hospice care? Journal of the American Geriatrics Society, 56(10), 1953–1958.CrossRefGoogle ScholarPubMed
Kline, R.B. (2005). Principles and practice of structural equation modeling, 2nd ed. New York: Guilford.Google Scholar
Marks, R. & Allegrante, J.P. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part 2). Health Promotion Practice, 6(2), 148–156.CrossRefGoogle Scholar
Muthén, L.K. & Muthén, B.O. (1998–2010). Mplus user's guide, 6th ed. Los Angeles: Muthén & Muthén.Google Scholar
National Hospice and Palliative Care Organization (2009). Family evaluation of hospice care: 2009 national average scores. Available at http://associationdatabase.com/aws/OHPCO/asset_manager/get_file/15611/fehc_2009_national_summary.pdf.Google Scholar
Petersen, S. (1992). Beyond hospice care: A survey of community outreach programs. The American Journal of Hospice & Palliative Medicine, 9(1), 15–22.CrossRefGoogle ScholarPubMed
Rhodes, R.L., Mitchell, S.L., Miller, S.C., et al. (2008). Bereaved family members' evaluation of hospice care: What factors influence overall satisfaction with services? Journal of Pain and Symptom Management, 35(4), 365–371.CrossRefGoogle ScholarPubMed
Rickerson, E., Harrold, J., Kapo, J., et al. (2005). Timing of hospice referral and families' perceptions of services: Are earlier hospice referrals better? Journal of the American Geriatrics Society, 53(5), 819–823.CrossRefGoogle ScholarPubMed
Schockett, E.R., Teno, J.M., Miller, S.C., et al. (2005). Late referral to hospice and bereaved family member perception of quality of end-of-life care. Journal of Pain and Symptom Management, 30(5), 400–407.CrossRefGoogle ScholarPubMed
Steinhauser, K.E., Christakis, N.A., Clipp, E.C., et al. (2000). Factors considered important at the end of life by patients, family, physicians, and other care providers. The Journal of the American Medical Association, 284(19), 2476–2482.CrossRefGoogle ScholarPubMed
Teno, J.M., Clarridge, B., Casey, V., et al. (2001). Validation of toolkit after-death bereaved family member interview. Journal of Pain and Symptom Management, 22(3), 752–758.CrossRefGoogle ScholarPubMed
Teno, J.M., Shu, J.E., Casarett, D., et al. (2007). Timing of referral to hospice and quality of care: Length of stay and bereaved family members' perceptions of the timing of hospice referral. Journal of Pain and Symptom Management, 34(2), 120–125.CrossRefGoogle ScholarPubMed
Tierney, R.M., Horton, S.M., Hannan, T.J., et al. (1998). Relationships between symptom relief, quality of life, and satisfaction with hospice care. Palliative Medicine, 12(5), 333–344.CrossRefGoogle ScholarPubMed
Tucker, L.R. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1–10.CrossRefGoogle Scholar
Welch, L.C., Teno, J.M. & Mor, V. (2005). End-of-Life care in black and white: Race matters for medical care of dying patients and their families. Journal of the American Geriatrics Society, 53(7), 1145–1153.CrossRefGoogle ScholarPubMed