Barriers of Acceptance to Hospice Care: a Randomized Vignette-Based Experiment.
J Gen Intern Med
; 38(2): 277-284, 2023 02.
Article
em En
| MEDLINE
| ID: mdl-35319086
ABSTRACT
BACKGROUND:
The per diem financial structure of hospice care may lead agencies to consider patient-level factors when weighing admissions.OBJECTIVE:
To investigate if treatment cost, disease complexity, and diagnosis are associated with hospice willingness to accept patients.DESIGN:
In this 2019 online survey study, individuals involved in hospice admissions decisions were randomized to view one of six hypothetical patient vignettes "high-cost, high-complexity," "low-cost, high-complexity," and "low-cost, low-complexity" within two diseases heart failure and cystic fibrosis. Vignettes included demographics, prognoses, goals, and medications with costs. Respondents indicated their perceived likelihood of acceptance to their hospice; if likelihood was <100%, respondents were asked the barriers to acceptance. We used bivariate tests to examine associations between demographic, clinical, and organizational factors and likelihood of acceptance.PARTICIPANTS:
Individuals involved in hospice admissions decisions MAINMEASURES:
Likelihood of acceptance to hospice care KEYRESULTS:
N=495 (76% female, 53% age 45-64). Likelihoods of acceptance in cystic fibrosis were 79.8% (high-cost, high-complexity), 92.4% (low-cost, high-complexity), and 91.5% (low-cost, low-complexity), and in heart failure were 65.9% (high-cost, high-complexity), 87.3% (low-cost, high-complexity), and 96.6% (low-cost, low-complexity). For both heart failure and cystic fibrosis, respondents were less likely to accept the high-cost, high-complexity patient than the low-cost, high-complexity patient (65.9% vs. 87.3%, 79.8% vs. 92.4%, both p<0.001). For heart failure, respondents were less likely to accept the low-cost, high-complexity patient than the low-cost, low-complexity patient (87.3% vs. 96.6%, p=0.004). Treatment cost was the most common barrier for 5 of 6 vignettes.CONCLUSIONS:
This study suggests that patients receiving expensive and/or complex treatments for palliation may have difficulty accessing hospice.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cuidados Paliativos na Terminalidade da Vida
/
Fibrose Cística
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Insuficiência Cardíaca
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Hospitais para Doentes Terminais
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Limite:
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article