Systematic Assessment to Improve Hospice Outcomes

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DESCRIPTION (provided by applicant): Complete, accurate, and systematic assessment is known to be essential for providing effective care in any setting. However, research reveals that this assessment is frequently missing from patient records, leading to care that are less than ideal. This need for careful assessment is no less necessary in hospice homecare. Growing numbers of patients are receiving hospice care each year; thus, improving assessment in this setting has the potential for improving care to thousands of patients each day. The primary aims of this study are to determine the efficacy of providing systematic feedback from standardized assessment tools for hospice patients and caregivers in improving hospice outcomes compared to usual practice, and in addition, using those standardized assessments, to identify symptom clusters in hospice patients and how they impact on patient and caregiver well-being. Patient outcomes to be measured include symptom intensity and distress, quality of life, depression, and spiritual well-being. Caregiver outcomes being measured include depression, spiritual well-being during active care, and depression 3 and 12 months after the death. The sample of 306 patient/caregiver dyads will be drawn from three large hospices that are partners in the Center for Hospice, Palliative Care and End of Life Studies at the University of South Florida. Patients must have cancer, and will be screened using the Short Portable Mental Status Questionnaire and the Palliative Performance Scale. In each hospice, two interdisciplinary care teams will be identified that provide homecare to equivalent groups of patients; one will be randomized as the control team and one the experimental team. Patients and caregivers on all teams will be admitted to the study 24-72 hours after admission to hospice and will complete all assessments. For the experimental teams, the RN's and social workers who are collecting the data will attend the weekly interdisciplinary team meetings and report the data they have collected during the previous week. Data collection and reporting will occur at baseline and then weekly for two weeks at which time the patients will be finished with the study. In order to monitor care changes that result from the enhanced assessments, charts will be audited to compare the numbers of home visits and medication and other careplan changes between the experimental and control groups. Caregivers will be visited again at 3 and 12 months after the death to evaluate whether the improved care provided to patients on the experimental teams resulted in significantly less depressive symptoms. Patient/caregiver dyads will be accrued for 30 months with an additional 12 months of follow-up data collection for depression data. Quantitative data will be analyzed using mixed models analysis, repeated measures multivariate analysis of variance, discriminant function analysis and cluster analysis.