THE HOSPICE DECISION - PSYCHOSOCIAL FACILITATORS AND BARRIERS

This study examined the social and contextual process of discussion an d decision making around the use of the hospice in order to clarify th e facilitative and obstructive aspects to hospice patient entry. Four participants groups of physicians, hospice and home health care patien t family survivors, and hospice and home health care staff, completed four complementary mail surveys of their discussions and decision proc ess for hospice care. Nonparametric analysis of the data reaffirmed th e central and key role of the physician as the expected initiator and gatekeeper of the hospice discussion and decision-making process. Phys icians were found generally aware of hospice and to have discussed hos pice with their patients, though that awareness and the frequency of h ospice patient discussions varied by the type of medical practice. Pat ient family survivors were unaware of hospice prior to the terminal il lness, with a majority of hospice patient family survivors receiving t heir initial hospice information from relatives. Implications of these results and issues for future research are identified.