Planning ahead

Abstract

As a natural part of life, older adults and their families must eventually confront death and end-of-life care decisions. Multiple studies documented that hospice and palliative care are optimal models of quality and compassionate care for the end of life. Nevertheless, hospice services are underutilized in the United States and the majority of patients enroll for short periods of times. The primary objective of this study was to identify the significant predictors of intentions to use hospice in older adults in general population. Secondary objectives were to assess if hospice knowledge differed by race, gender, education, and income; and compare the levels of palliative care and hospice knowledge. The Theory of Planned Behavior was used as the theoretical framework. The sample included 169 community-dwelling older adults (mean age 69±7.8; 69% females; 95% White). Spearman correlation, analyses of variance, and multiple linear regression were used for the analyses. Results indicated that hospice knowledge (=0.31, p<.001), subjective norms (=0.19, p=.003), perceived control (=0.36, p<.001), and preferences of end-of-life care (=0.17, p=.002) were significant predictors of intentions to use hospice. Together these variables explained 55.5% of the variance in intentions to use hospice. Though overall hospice knowledge scores were high, only 56% of the participants knew that Medicare pays for hospice. Additionally, 47% did not know that the most common place for hospice care to be provided is at home. Participants with low hospice knowledge were more likely to be older and lower income. Older adults reported less knowledge of palliative care than hospice. Based on a theoretical framework and empirical results, the current study supports the hypothesis that intentions to use hospice in older adults are influenced by hospice knowledge, preferences for quality of life rather than aggressive treatments, normative beliefs towards hospice and perceived control to use hospice if faced with a terminal illness. These results provide better understanding of where to focus while developing interventions to educate older adults about hospice care options before a crisis happens, when patients and families are forced to comprehend complex information about hospice and make health care decisions within a short timeline.