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Hospice provides essential psychosocial and supportive care to people at the end of life (EOL). Timely access to multidisciplinary hospice care services for cancer patients will allow patients to better cope with pain and save costs while improving the quality of life of terminally ill patients (Bhattacharya et al., 2018). That is due to less invasive EOL treatment and less psychiatric morbidity in caregivers. Late admission to hospice is still common among cancer patients, despite all the benefits, so hospice services are underused.
A Comparison of Research Questions
A large number of researchers have studied the issue of the impact of late admission of cancer patients to a hospice. Each study, while narrowly focusing on a topic, is interconnected. Mulville et al. set out to evaluate and identify the reasons that prevent timely admission to the hospice of cancer patients at the end of life (Mulville et al., 2018). Researchers are convinced that once barriers are identified, significant changes can be made to improve this practice (Mulville et al., 2018). Thus, the research question focuses on whether shorter hospice stays lead to reduced quality of life and aggressive treatment. Allsop et al. are investigating factors influencing the duration of palliative care, focusing on providing specialized palliative care by hospices (Allsop et al., 2018). It is essential to identify the barriers that limit the broad integration of palliative care.
Most cancer patients are still admitted to hospices shortly before death, which significantly reduces the quality of care and exposes patients to great suffering. Giesendanner et al., in their study, examine the opinion of general practitioners on the frequency and reasons for referral to the hospital at the end of life. Understanding the need for palliative care is essential when planning services for outpatients, so it is important to explore and explain the benefits of timely access to hospice care (Giezendanner et al., 2018). As research questions, scientists consider the reasons for early becoming in the hospice.
Kirk et al., in a study of late hospice admission, evaluated an adaptive intervention in inpatient care to describe its feasibility and outcomes. Interventions report with high accuracy and a low burden on required workflow changes. The survey questions addressed the need to improve the timeliness of referrals to hospices (Kirk et al., 2019). Many indicators of patient registration indicate that patients are willing to examine their needs, goals, and preferences in care. That will help understand what factors need to be improved to increase the number of critically ill patients in hospice care. Thus, all research aims to increase the satisfaction of patients and help them live the period before death as painlessly as possible. However, each study addresses different questions that serve the same general purpose.
A Comparison of Sample Populations
Articles Mulville et al., and Kirk et al., to a greater extent, study the human factor that influences the choice of patients in favor or against spending time in a hospice. Therefore, the researchers looked at data from cancer patients at high risk of death. Mulville et al. looked at data from 418 deceased patients with various cancers to determine what percentage were in hospices and for how long before death (Mulville et al., 2018). These data are reasonably consistent with the research questions, designed to compare statistical differences between patients whose length of stay in hospice varied significantly. Kirk et al. conducted a pilot test in two non-profit agencies, where the average daily census was 211 and 270 people, and the average length of stay was 25.5 and 21.5 days (Kirk et al., 2019). Both qualitative and quantitative data were collected: patient registration rates and experience of pilot staff, respectively. All information was analyzed to evaluate intervention and improve quality.
The population sample of Allsop et al. significantly differ from other studies. In examining factors affecting the length of stay in hospices, the researchers looked at 42,758 deaths from 64 hospices in the United Kingdom (Allsop et al., 2018). However, this sample helped to achieve the goal, and it was found that age is the main factor. A similar extensive study is described by Giesendanner et al., who collected data from 2,000 general practitioners in Switzerland (Giezendanner et al., 2018). The main difference is that the researchers worked with healthcare professionals to conduct the survey.
A Comparison of the Limitations of The Study
A limitation in the study by Mulville et al. is that it is not possible to determine whether hospice services have been discussed with patients with healthcare professionals before, resulting in rejection. In addition, considerably factors can affect the results of a study. A study by Allsop et al. was conducted in different locations, which could have influenced the results, which were 33% lower than the researchers expected. Giesendanner et al. in the article does not describe the limitations. However, it should be borne in mind that the factors influencing the patient’s decision depend only on the patient (Oh et al., 2019). Therefore, general care physicians can only report on measures that need improvement, mainly from a professional point of view (Rowe et al., 2018). Kirk et al., in the limitations section, report a small sample size that may not be accurate. In addition, the qualitative data analysis was performed by the lead author of the article, which greatly limited the study.
Recommendations for Further Research
Further research may be aimed at studying the factors of patients’ refusal to stay in hospice. These can be external factors, such as the general condition of hospices and the level of workers’ professionalism, and internal, which include unwillingness to part with the family. In addition, it is possible to analyze how many of the patients who were in the hospice are single and how many have families. It can help in understanding the intrinsic factors of patient rejection.
References
Allsop, M. J., Ziegler, L. E., Mulvey, M. R., Russell, S., Taylor, R., & Bennett, M. I. (2018). Duration and determinants of hospice-based specialist palliative care: A national retrospective cohort study.Palliative Medicine, 32(8), 1322–1333.
Bhattacharya, P., Dessain, S. K., & Evans, T. L. (2018). Palliative care in lung cancer: When to start.Current Oncology Reports, 20(11).
Giezendanner, S., Bally, K., Haller, D. M., Jung, C., Otte, I. C., Banderet, H.-R., Elger, B. S., Zemp, E., & Gudat, H. (2018). Reasons for and frequency of end-of-life hospital admissions: General practitioners’ perspective on reducing end-of-life hospital referrals.Journal of Palliative Medicine, 21(8), 1122–1130.
Kirk, M. A., Hanson, L. C., Weinberger, M., Haines, E. R., Rokoske, F. S., Powell, B. J., & Birken, S. A. (2019). Pilot test of an adapted intervention to improve timeliness of referrals to hospice and palliative care for eligible home health patients. Journal of Palliative Medicine, 22(10), 1266–1270.
Mulville, A. K., Widick, N. N., & Makani, N. S. (2018). Timely referral to hospice care for oncology patients: A retrospective review.American Journal of Hospice and Palliative Medicine®, 36(6), 466–471.
Oh, I. S., Filion, K. B., Jeong, H. E., & Shin, J. Y. (2019). An empirical assessment of immeasurable time bias in the setting of nested case‐control studies: Statins and all‐cause mortality among patients with heart failure.Pharmacoepidemiology and Drug Safety, 28(10), 1318–1327.
Rowe, A. K., Rowe, S. Y., Peters, D. H., Holloway, K. A., Chalker, J., & Ross-Degnan, D. (2018). Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries: A systematic review.The Lancet Global Health, 6(11).
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